In This Issue

• Commonwealth CARE and LEGAL Immigrants
• Commonwealth CHOICE and UNDOCUMENTED Immigrants
• MBTA Board OK's Fare Hikes
• Open Enrollment for Acquired Brain Injury Waiver Program
• Database- Use of Antipsychotics in SNFs
• TPS for Syrians

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues
• Of Clinical Interest

Questions, comments about the newsletter? Contact Ellen Forman, x6-5807.

Commonwealth CARE- Reenrollment for LEGAL Immigrants: Members Must Enroll in a Plan or Lose Limited/HSN

As reported previously (Legal Immigrant Transition to Commonwealth CARE, MGH Community News, February 2012), due to a court decision, Massachusetts must allow otherwise eligible legal immigrants access to Commonwealth Care. During Phase 1 of the transition process, those who had been enrolled in the Bridge program were enrolled in full Commonwealth Care. Phase 2 is now underway. This pertains to legal immigrants who are currently on MassHealth Limited and/or Health Safety Net who were eligible for the Bridge program, but weren't enrolled because it was closed to new applicants. These individuals are currently either on MassHealth Limited/HSN or HSN, depending on their categorical eligibility.

These individuals will receive a letter informing them that they are now eligible for Commonwealth Care and that they must select a plan for a May 1 effective date. There will be no auto-enrollment. Some of these members may be reluctant to switch from HSN because they have had almost no patient costs. If they do not select a plan within 90 days of the date on their letter, however, they will be terminated from MassHealth Limited and Health Safety Net.

Most Partners sites accept CeltiCare and Neighborhood Health Plan, but not Network Health and BMC HealthNet. Plan Type I-eligible individuals (income below 100% FPL) will have a choice of only CeltiCare or Network Health, the state's lowest cost plans.

New Applicants and Open Enrollment:

New eligible legal immigrants will be enrolled in Commonwealth Care (anyone who applied after March 26, 2012).

All Commonwealth Care members will have a chance to switch plans during this year's open enrollment, June 1-22. All members, regardless of plan type, will have unlimited choice of plans in their service area during open enrollment.

-Adapted from: Health Care For All http://www.hcfama.org/_data/n_0001/resources/live/AWSS%20CommCare%20Reintegration%20Plan.pdf

Commonwealth CHOICE and Undocumented Immigrants

Individuals who don't have access to health insurance may purchase private Commonwealth Choice plans on www.mahealthconnector.org each year during an annual open enrollment period from July 1 - Aug 15. For the past several years, the insurers have turned away individuals without a social security number. The Division of Insurance has now prohibited that practice, and beginning this July, undocumented immigrants without a social security number will be eligible to purchase private insurance if they can afford the costs.

Note: Those who have been covered under Health Safety Net or Mass Health Limited will likely have to pay a premium and/or be charged co-pays for services like MD visits and prescriptions under Commonwealth Choice. Commonwealth Choice, however, offers more comprehensive coverage.

-Thanks to Martha Southworth for sharing this information.

-Adapted from Draft email to your staff re: immigrant program changes, Kim Simonian, MPH, Associate Director, Patient Access, Partners HealthCare - Community Health , March 05, 2012.

MBTA Board OK’s Fare Hikes, Service Cuts

As reported last month (MBTA Revised Fare and Service Plan- Major Fare Increase for The RIDE, MGH Community News, March 2012), the MBTA had proposed a plan that combined fare hikes with more modest cuts than proposed in a previous proposal. The new plan was approved by a vote of the MBTA board of directors on April 4th. The changes are slated to go into effect on July 1.

One-way fares for the Ride, the T’s door-to-door service for the disabled, will rise from $2 to $4 or even $5 (for outlier locations, after hours and same-day or “will call” rides). (For more information see the March article.)

The fare increases and service cuts got the T only a little over half way to erasing its deficit. The rest came from one-time sources, including about $5 million in leftover snow and ice removal funds, and $51 million from a surplus in a little-known account fed by motor vehicle inspection fees. That money requires legislative approval before it can be spent on the T.

Governor Deval Patrick recently reminded the public that he tried unsuccessfully to persuade legislators three years ago to raise the gas tax to support the state’s heavily indebted transportation systems. He called on lawmakers to join him next year in addressing the crisis.

-See the full The Boston Globe article…

Open Enrollment for Acquired Brain Injury Waiver Program – Help to Move Out of Long-Term Care Facilities

Under the Hutchinson case settlement, Massachusetts residents of nursing homes with acquired and traumatic brain injury may receive services to move home or to a less institutional residential setting. 

Waivers are open to eligible individuals with either ABI or TBI. (Note: definitions vary, but TBI or Traumatic Brain Injury typically refers to injuries from a blow to the head or rapid head movement, while ABI or Acquired Brain Injury is often an umbrella term including TBI, and also situations where brain cells are damaged or killed by toxic substances, lack of oxygen, pressure, infection or stroke.)

• The ABI Waiver with Residential Habilitation (ABI-RH) is for Medicaid-eligible persons with ABI who are patients in a nursing home or chronic or rehabilitation hospital and need supervision and staffing 24 hours a day, seven days a week and who want to move to a provider-operated residence in the community. Open enrollment for residential ABI Waivers was May 1-21, 2012 (more information). Open enrollment periods have typically been offered annually.
• The ABI Waiver with No Residential Habilitation (ABI-N) is for Medicaid-eligible persons with ABI who are patients in a nursing home or chronic or rehabilitation hospital and  who want to move to their own home or apartment or to the home of someone else. Enrollment is ongoing for those who have been a resident in a facility for at least 90 days (no need to wait for an open enrollment period).

Applications, Brochures, Forms and Fact Sheets:

More information on the Brain Injury Association of MA website: http://www.biama.org/hutchinson.html#abiwaivers or call 866-281-5602.

Report: Overuse of Antipsychotics in MA SNFs- New Database Available

A new Boston Globe investigation has found many Massachusetts nursing homes make heavy use of antipsychotic drugs to pacify residents who do not have psychosis or a related condition that nursing home regulators say warrants their use. The US Food and Drug Administration has issued black-box warnings - the agency’s most serious medication alert - about potentially fatal side effects when antipsychotics are taken by patients with dementia. The medications increase the risk of lethal infections and cardiovascular complications in these elderly patients, the FDA says. In addition, the drugs can cause dizziness, a sudden drop in blood pressure, abnormal heart rhythms, blurred vision, and urinary problems.

The Globe has developed an online database to allow consumers for the first time to compare nursing homes’ use of antipsychotics. (See bostonglobe.com/nursinghome).

Among the Globe report’s findings:

• In 21 percent of US nursing homes in 2010, at least one-quarter of the residents without illnesses recommended for antipsychotic use received the medications. In Massachusetts, the proportion was 28 percent.
• There is a clear link between the rate of antipsychotic use in a nursing home and its staffing level.

The Centers for Medicare & Medicaid Services (CMS) recently launched a multiyear initiative focused on training nursing home inspectors to better identify problems, and on helping homes to care for people with dementia without resorting to antipsychotics. CMS is planning this summer to post data on its website about antipsychotic use in each nursing home.

Dr. Madeleine Biondolillo, the nursing home regulator who directs the state Bureau of Health Care Safety and Quality, said her agency is hampered in its efforts to offer more guidance because of state budget cuts.

-Read Part 1 in the Boston Globe…

-Read Part 2: How some nursing homes have eliminated overuse of antipsychotics.

See related story below (Antipsychotics Linked to MI Risk in Dementia Patients).

Temporary Protected Status Designated for the Syrian Arab Republic

Due to the violent upheaval and deteriorating situation in the Syrian Arab Republic (Syria), U.S. Citizenship and Immigration Services (USCIS) announced recently that eligible Syrian nationals (and persons without nationality who last habitually resided in Syria) in the United States may apply for Temporary Protected Status (TPS).  Details and procedures for applying for TPS are provided in the Federal Register notice available at www.uscis.gov/tps. This TPS designation is effective through September 30, 2013. 

The designation means that eligible Syrian nationals will not be removed from the United States, and may request employment authorization. The 180-day TPS registration period begins immediately and ends on September 25, 2012.  Although the Federal Register notice erroneously states that TPS applications must be filed March 29, 2012 through September 30, 2013, USCIS will only accept applications filed through September 25, 2012. USCIS is working to correct the public information on the registration deadline date.

To be eligible for TPS, Syrians must meet all individual requirements for TPS, including demonstrating that they have continually resided and been continually physically present in the United States since March 29, 2012. All individuals who apply for TPS will undergo a thorough security check.  Individuals with criminal records or who pose a threat to national security are not eligible for TPS and their applications will be denied. The eligibility requirements are fully described in the Federal Register notice and on the TPS webpage at www.uscis.gov.

Syria joins El Salvador, Haiti, Honduras, Nicaragua, Somalia, Sudan, and South Sudan as countries currently designated for TPS.

-See the full USCIS Press Release...

Roxbury Village- Young Adult Transitional Housing

A version of this story was previously e-mailed to the Women’s and Children’s team.  

Roxbury Village is now accepting applications. Roxbury Village serves young adults 18-22 years of age who have been discharged from state systems of care or are about to be discharged and/or are (or will be) homeless. The objective of Roxbury Village is not only to obtain and maintain stable, safe, affordable housing for these young people, but to put them on the path to becoming successful, contributing members of society. 

Case Management will be intense, flexible, tailored to meet the individual’s needs and will be implemented as long as needed for the individual to become self sufficient.

For more information, contact: Lavette Pitts, Program Director at 617-783-8035

-Thanks to Amanda Breen, M.S., MGH Violence Intervention Advocate (VIAP), for sharing this resource.

HomeCorps Foreclosure Prevention Program Coming Soon

Massachusetts attorney general Martha Coakley recently unveiled a new foreclosure-prevention program. Called HomeCorps, the program will offer counseling and grants worth $16 million to Massachusetts homeowners, and another $10 million in grants to individuals and communities combating blight caused by foreclosures.

Earlier this year, attorneys general nationwide, including Coakley, reached a $25 billion deal with Bank of America Corp., JPMorgan Chase & Co., Wells Fargo & Co., Citigroup Inc., and Ally Financial Inc. over the lenders’ role in the foreclosure crisis. This program uses the first portion of that settlement.

Homeowners can find out whether they qualify for assistance through the program and receive other information by calling the HomeCorps hotline at 617-573-5333.

-See the full Boston Globe article…

More information…

Medicare Reminder- SNF Coverage

Eligibility

If you have a Medicare Advantage Plan, your plan’s coverage of SNF stays may be different than as explained below. Contact your plan directly to confirm costs and coverage of SNF stays.

Original Medicare may help pay for care in a Medicare-certified skilled nursing facility (SNF) if:

• You need skilled nursing care seven days a week or skilled therapy services at least five days a week;
• You were formally admitted as an inpatient* to a hospital for at least three consecutive days in the 30 days prior to admission in the SNF; and
• You had Medicare Part A before you were discharged from the hospital.
• You need care that can only be provided in a SNF.

If you meet these requirements, Medicare should cover the SNF care needed to improve your condition or maintain your ability to function.

*If you were admitted to a hospital under observation status or only received emergency room services, this time does not count toward meeting the three-day qualifying stay requirement for SNF coverage.

Coverage

Every benefit period, Original Medicare will pay the full cost of the first 20 days you stay in the SNF and part of the cost of another 80 days, as long as your stay is medically necessary. A benefit period begins the day you begin to receive inpatient care and ends when you have been out of the hospital or SNF for 60 consecutive days.

If you need more than 100 days of care in a SNF within one benefit period, you will need to pay for this additional care yourself. If you have long-term care insurance, your policy may cover this care, or if you qualify for Medicaid, Medicaid may cover your stay.

If you have a Medicare Advantage Plan, your plan’s coverage of SNF stays may be different. Contact your plan directly to confirm costs and coverage of SNF stays.

Learn more about SNF coverage at www.medicareinteractive.org.

-Adapted from Medicare Watch, Medicare Rights Center, April 12, 2012 (rev 5/15).

Medicare Reminder- The Prescription Drug Donut Hole

The prescription drug coverage gap, or donut hole, starts when your total drug costs—including what you and your plan have paid—reach $2,930 in 2012. In the past, most people had to pay the full cost of their drugs in the coverage gap. However, because of the Affordable Care Act (ACA), the government now helps you pay for your drugs in the coverage gap: in 2012, you will receive a 50 percent discount on brand-name drugs and a 14 percent discount on generics. These discounts will increase each year until 2020, when the coverage gap will close, and you will pay no more than 25 percent of the cost of your drugs at any point during the year.

You get out of the coverage gap in 2012 when you have paid $4,700 in out-of-pocket costs for covered drugs since the start of the year. Your Medicare prescription drug plan should keep track of how much money you have spent out-of-pocket on your medications. This information should be printed on your monthly statements. You should keep your pharmacy receipts so that you can confirm that this information is correct.

If you have Extra Help, the federal program that helps people with limited incomes pay the costs of Medicare prescription drug coverage, you will not have a coverage gap. In 2012, individuals with monthly incomes up to $1,396 ($1,891 for couples) and assets up to $13,070 ($26,120 for couples) may be eligible for Extra Help. Contact the Social Security Administration at 1-800-772-1213 for more information.

Learn more about the prescription drug donut hole and how you get out of it at www.medicareinteractive.org.

-From Medicare Watch, Medicare Rights Center, Volume 3, Issue 12, March 29, 2012.

HHS Announces the Formation of the New Administration for Community Living

The federal Centers for Medicare & Medicaid Services (CMS) recently announced the creation of the new Administration for Community Living (ACL) within the Department of Health and Human Services (HHS). The ACL combines the Administration on Aging (AoA), the Office on Disability, and the Administration on Developmental Disabilities into a single agency. The ACL is dedicated to increasing access to services and supports that allow older adults and people with disabilities to live at home and in their communities. In a statement, HHS Secretary Kathleen Sebelius said that the supports the ACL will aim to “go well beyond health care and include the availability of appropriate housing, employment, education, meaningful relationships and social participation.”

Kathy Greenlee, current Assistant Secretary for Aging at the AoA, will be the new Administrator of the ACL. Greenlee announced the foundation of the new agency on a call to stakeholder groups during which she said that the ACL will have a broad focus and serve as a new space for aging and disability initiatives and policies at the federal level. According to the ACL’s website, though the agency itself is new, the day-to-day management of individual departmental programs, including those that fall under the Older Americans Act and the Developmental Disabilities Assistance and Bill of Rights, will remain relatively unchanged.

• Read Secretary Sebelius’ statement on the creation of the Administration for Community Living.
• Visit the website of the Administration for Community Living.

-Adapted from Medicare Watch, The Medicare Rights Center, Volume 3 Issue 15, April 19, 2012 available at: http://www.medicarerights.org/issues-actions/medicare-watch.php.

Understanding the Medicare Trust Fund

In their recently released report, the Medicare trustees have projected that the Part A trust fund, also known as the Medicare Hospital Insurance (HI) trust fund, will remain solvent through 2024. This is the same conclusion that the trustees made last year. Reforms included in the Affordable Care Act (ACA) have strengthened Medicare’s financial outlook and extended solvency through 2024.

The Part A trust fund and its solvency are frequently misunderstood. The trust fund is a financing mechanism for Medicare Part A, which covers inpatient services such as hospital stays and skilled nursing facility care. The trust fund is financed through a combination of payroll taxes and other revenues. Although, as noted above, the trustees have recently reported that the trust fund is solvent through 2024; that does not mean that the trust fund or Medicare will cease to exist in 2025. The trustees found that the Part A trust fund will be able to cover 100 percent of the costs of Medicare’s Part A benefits through 2024. After 2024, the trust fund will still be able to provide coverage, though at a lesser rate. According to the Center on Budget and Policy Priorities (CBPP), starting in 2025, Medicare will still be able to cover 87 percent of all inpatient costs, and over the next 75 years, the trust fund, on average, will be able to cover 74 percent of Medicare’s inpatient costs. A number of factors can affect the Medicare Part A trust fund. For example, since the trust fund is partially paid for through payroll taxes, an economic downturn could result in less people paying into the system. As the economy recovers, so will the trust fund.

Medicare Part B, which covers outpatient services such as visits to doctors’ offices, and Medicare Part D, which covers prescription drugs, are financed through beneficiary premiums and general revenues, not through the trust fund.

While action will need to be taken to make up for the future financing shortfalls of Medicare Part A after 2024, it is important to recall that congress has been taking this kind of action since 1970 to extend the life of the trust fund to ensure that people with Medicare are able to access affordable, comprehensive and quality coverage. Unfortunately, supporters of drastic changes to Medicare, such as premium support, point to the potential insolvency of the trust fund to justify proposals that would shift substantially higher out of pocket costs onto beneficiaries and their families as well as undermine the consumer protections and guaranteed benefits that the Medicare program currently provides. Strengthening the Medicare trust fund can be done without gutting Medicare’s guarantees.

Read the Center on Budget and Policy Priorities report, “Medicare is not Bankrupt.”

Read the Center for Medicare and Medicare Services press release and Trustees Report

- From Medicare Watch, Volume 3, Issue 16, The Medicare Rights Center, April 26, 2012.

Dietary Trans Fats Linked to Aggression

New research indicates that consumption of dietary trans fatty acids is associated with irritability and aggression.

The cross-sectional study of 945 adult men and women provides the first evidence linking trans-fat consumption to adverse behaviors that affect others. These range from impatience to overt aggression, lead author Beatrice A. Golomb, MD, PhD, from the University of California, San Diego, told Medscape Medical News.

"There were studies showing that omega-3 fatty acids were associated with increased agreeableness and reduced impulsivity, and there's evidence that trans fats adversely affect ability to create the long-chain omega-3 fatty acids that are favorable for your brain, and that prompted us to study this further," Dr. Golomb said.

The study was published online March 5 in PLoS One.

-See the full article summary on Medscape.com

Antipsychotics Linked to MI Risk in Dementia Patients

Antipsychotic medications used to treat behavioral symptoms in elderly patients with dementia are associated with an increased risk for myocardial infarction (MI), especially during the first month of use, new research suggests. The research was a retrospective cohort study of more than 20,000 patients older than 64 years.

The hazard risk ratios were highest within the first 30 days after treatment initiation (RR, 2.19) and dropped continuously at each subsequent assessment point.

The investigators note that this is the first study to show this particular increased risk in this patient population. They add that it also "highlights the need for communicating such risk and for close monitoring of patients during the first weeks of treatment."

"Antipsychotics are widely prescribed to elderly with dementia, despite the presence of safety warnings," co-investigator Yola Moride, PhD, professor in the Faculty of Pharmacy at the University of Montreal, Canada, and researcher at the University of Montreal Research Center, told Medscape Medical News. "Antipsychotics are known to be associated with an increase in the risk of stroke and the risk of death in the elderly population with dementia," reported Dr. Moride.

The study was published online March 26 in the Archives of Internal Medicine.

-See the full article summary on Medscape.com…

Painkiller Opana, New Scourge of Rural America

Prescription drug abuse is the new scourge of rural America. It now leads to more deaths in the United States than heroin and cocaine combined, and rural residents are nearly twice as likely to overdose on pills than people in big cities, according to the Centers for Disease Control.

While methamphetamine addiction has long been associated with small towns, prescription painkillers have overtaken meth as the most abused drugs in places such as southern Indiana, according to local authorities.

Opana, a powerful opioid painkiller containing oxymorphone, is the hot new prescription drug of abuse, sometimes with tragic consequences.

Potent, Deadly

Law enforcement officials are alarmed by the rise of Opana abuse, which they said started after Oxycontin (oxycodone) was changed in late 2010 to make that drug more difficult to snort or inject for a heroin-like high.

Opana abuse can be deadly because it is more potent, per milligram, than Oxycontin, and users who are not familiar with how strong it is may be vulnerable to overdosing.

Opana, known by such street names as "stop signs," "the O bomb," and "new blues," is crushed and either snorted or injected. Crushing defeats the pill's "extended release" design, releasing the drug all at once.

Endo Pharmaceuticals, which produces Opana, announced in December that it would reformulate the product. The new pill is being manufactured now. The new formulation makes it difficult to crush and it turns viscous or "gooey" if an abuser tries to add liquid to it, said company spokesman Kevin Wiggins. When used properly, Opana is indicated for chronic low back and osteoarthritis pain, and cancer pain.

But the old form of Opana is still available, and pharmacy and home robberies are on the rise as addicts search for a way to get their fix, according to police.

-See the full article on Medscape.com…