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MGH Community News |
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MGH Community News |
| September 2012 | Volume 16 • Issue 9 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Emergency Assistance (Family Shelter) New Eligibility Categories As reported previously, (Emergency Assistance (EA) Family Shelter Restrictions- Phase 1 Has Started, MGH Community News, August 2012 and in July) the state’s family shelter system, Emergency Assistance (EA) has dramatically changed eligibility status. Several new changes have been implemented over the past few months including a new requirement to demonstrate Massachusetts’ residency and new much more restrictive definitions of homelessness. In August, the program started using a new definition for those qualifying under “Category 4”. See link above for details. In September, additional categories for demonstrating homelessness have been added.
These current categories are in place for a 60 day comment period before becoming final. |
Advocacy Opportunities
The RIDE- New Premium Fares Starting, But In-Person Assessment Delayed New Premium Fares As you are aware, The RIDE fares increased on July 1, 2012 to $4* each way for most rides (*or twice the full fare for a comparable fixed-route trip, if it is lower.) As of October 1, The RIDE will institute a Premium Fare of $5 each way for certain trips. The ADA requires the MBTA provide The RIDE to those who can’t use their regular fixed-route service (bus and subway). But they are not required to offer greater service than is available if one was able to use regular fixed-route service. Specifically they are only required to offer The RIDE within ¾ mile of regular fixed-route service and during the regular hours of operation. The RIDE does offer service outside the required area and offers extended hours, but these services will now be subject to the $5 Premium Fare. The RIDE website (http://www.mbta.com/fares_and_passes/ride/) now has maps that show Premium ride locations and times of day so that users can estimate whether a particular trip is subject to the Premium Fare. When one schedules a trip with The RIDE, the customer service representative should inform the user of the cost of the trip, so the user should know in advance. The RIDE In-Person Assessment Delayed According The RIDE staff, the start of In-Person Assessment has been delayed. It is planned to start some time this fall, with the current estimate of a November 1, 2012 start date. They promise a significant outreach effort in advance of this new change, so stay tuned. Absentee Ballots- Plan Ahead for the Election The Community Resource Center regularly gets calls the day of a big election asking how a hospitalized patient can vote. Hospitalized patients can vote via Absentee Ballot, but they need to plan ahead. Patients with planned admissions who are still at home: Registered voters who know in advance that they will be hospitalized on election day can vote absentee at their city or town hall up to two or three weeks before the election. They can make their application for an absentee ballot and cast their vote in one visit. Patients who are hospitalized – and it is more than 5 days before the election: Registered voters who can’t make it to city hall can mail a request for an absentee ballot to be mailed to them. Or certain family members (limited to: a spouse or person residing in the same household, in-laws, father, mother, sister or brother of the whole or half blood, son, daughter, adopting parent or adopted child, stepparent or stepchild, uncle, aunt, niece, nephew, grandparent or grandchild.) can help. The family member would complete an Absentee Ballot Application by a Family Member and either mail it or hand-deliver it to city hall to have an absentee ballot mailed to the patient either at home or at an alternate address (i.e., the hospital). Last Minute- within 5 Days of the election: If a voter has entered a health care facility anytime after twelve o’clock noon of the 5th day before the election, contact the city or town clerk about the proper procedure to be followed. To be counted, a completed ballot must be received by the time the polls close on Election Day (generally 8:00 pm). See our website under Voting Rights or http://www.sec.state.ma.us/ele/eleifv/howabs.htm for more information and Spanish versions of the forms above. Elder Utility Protection: National Grid Changing Procedures National Grid (NGRID) is launching some new practices for those who claim elder protection against utility shut-off (all adults in household are 65 or over). New Collections Calls First, NGRID will now call the customer to ask the customer to make payments. It is NOT illegal for a company to ask someone in a protected status – elder protection, serious illness protection, infant protection – to make payments. But seniors may not fully understand that they are still protected against termination even if they don’t pay, and may feel that they have to immediately pay the utility bill, even if it means they won’t have enough money for food or medicine. New Annual Eligibility Recertification Second, NGRID will start asking seniors to recertify their eligibility annually. Of course, no one gets younger, but the household composition might change. Remember that ALL adults in the household must be 65 or over. So if the 70-year old marries a 63-year old that household is no longer eligible for senior protection. Macro Advocacy- Issue Tracking The National Consumer Law Center will be collecting issues and concerns related to both of these scenarios. Please contact Ellen Forman for NCLC’s contact information. -Adapted from National (sic) Grid changing procedures for elder-protected accounts, Charlie Harak, National Consumer Law Center, utilitynetork@lists.nclc.org, September 14, 2012. Immigration: Deferred Action for Childhood Arrivals Clarification As reported last month (Immigration: Deferred Action for Childhood Arrivals [DACA] Applications Now Accepted, MGH Community News, August, 2012), certain young adult undocumented immigrants brought to the country as children can now apply for a renewable work-permit. This month US Citizenship and Immigration Services (USCIS) clarified expectations, relieving applicants who worried they would need exhaustive proof of their whereabouts for the past 5 years. Eligible applicants must have come to the United States before they turned 16, be age 30 or younger, be high school graduates or in college, or have served in the military, and they cannot have serious criminal records. They also must have lived in the United States since June 2007. The new guidelines say applicants should provide as much evidence as reasonably possible that they stayed in the United States — ideally for every year — but that they don’t have to account for every day of the last five years. The government also reassured employers that were nervous about providing evidence they hired an illegal immigrant. It said documents will not be used against employers unless they committed ‘‘egregious violations of criminal statues or widespread abuses.’’ -See the full The Boston Globe article…
Medicare Open Enrollment: October 15 - December 7 October 15 to December 7 is when ALL people with Medicare can change their Medicare health plan and prescription drug coverage for 2013. Information on 2013 plans will be available beginning in October. Everyone is encouraged to carefully review their current plan’s information for 2013 as coverage (such as covered drugs, tiers, etc.) and patient costs may change from year to year. If one is satisfied that his or her current plan will meet their needs for next year, he or she doesn’t need to do anything. For more information
-Adapted from http://www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html?redirect=/center/openenrollment.asp and http://www.cms.gov/Center/Special-Topic/Open-Enrollment/Downloads/Article-Medicare-Open-Enrollment-Provider.pdf MassHealth DOR Income Update and Express Lane Renewal Beginning on September 24, 2012, MassHealth implemented both a new Department of Revenue (DOR) Job Update process and a new Express Lane renewal process for certain MassHealth, Commonwealth Care, and Health Safety Net members. New Job Update Process:
New Express Lane Renewal Process:
-Adapted from Call-In to Learn about MassHealth's New DOR Job Update and Express Lane Renewal Processes, MA Health Care Training Forum, September 12, 2012 and the accompanying presentation New MassHealth Processes: Job Update and Express Lane Renewal, Massachusetts Health Care Training Forum Call, September 19, 2012, available at: http://archive.constantcontact.com/fs069/1101674716790/archive/1110957676863.html. Long-Term Care Insurance Reform Passes the House After many years of advocacy, the Massachusetts House of Representatives has passed legislation updating regulation of long-term care insurance (LTCI). It is expected to pass the Senate and that the Governor will sign it. As an incentive to encourage seniors to purchase LTCI, Massachusetts provides those with policies providing at least $125,000 of coverage protection from any MassHealth claim for estate recovery against their home. However, MassHealth has long interpreted this provision quite narrowly, only permitting the waiver if the senior still has $125,000 of coverage when she enters a nursing home. If she depleted the policy paying for home or assisted living care before entering the nursing home, she would lose the waiver. The new law clarifies the estate recovery waiver provision as valuing a policy at the time of purchase, not the time of nursing home admission. -Adapted from News from Margolis & Bloom, LLP - September 24, 2012, Margolis & Bloom, LLP, September 25, 2012. See the archive.
Massachusetts Moves Ahead on Duals Demonstration The Centers for Medicare & Medicaid Services (CMS) and the state of Massachusetts recently released a Memorandum of Understanding (MOU) outlining details related to the state’s demonstration program to test managed care models for dual eligibles (beneficiaries enrolled in both Medicare and Medicaid). The MOU is essentially a statement of principles that CMS and Massachusetts agree will guide the development, implementation and evaluation of the state’s demonstration. Starting April 2013, Massachusetts will be among the first states to begin enrolling individuals in its duals managed care demonstration. Careful review of the Massachusetts MOU by advocates is critical, given that this document will serve as a model for MOUs with other states. Excerpts of Summary of MOU from the National Senior Citizens Law Center: Under the MOU, Massachusetts and CMS will contract with managed care plans to provide all Medicare and Medicaid services to dual eligibles aged 21-64. There are 109,000 of these individuals in Massachusetts. The managed care plans, referred to as Integrated Care Organizations (ICOs), will be paid on a capitated basis. The demonstration will last from April 1, 2013 to December 31, 2016. Supplemental Services and Care Continuity The ICOs will offer care coordination to all enrollees through a care coordinator or clinical care manager for medical and behavioral health services. Care coordination will also be offered through an Independent Living and Long-Term Supports and Services (LTSS) coordinator contracted from a community based organization. In addition to the requirement that they provide all Medicare and Medicaid services, ICOS must also cover supplemental benefits including: day services, home care services, respite care, peer support/navigation, care transitions assistance, home modifications, community health workers, medication management, non-medical transportation, preventive, restorative and emergency dental benefits, PCA, and DME. Unfortunately, the MOU provides no standards for determining when these services must be provided. ICOs must allow enrollees to maintain current providers for 90 days, or until the ICO completes a service assessment, whichever is longer. In urgent or emergency situations, the ICO must reimburse an out-of-network provider at the Medicare or Medicaid FFS rate applicable for the service. Beyond the 90 day transition period, under certain defined circumstances, plans will be required to offer an out-of-network agreement to providers who are currently serving the enrollee and are willing to continue serving them. Enrollment ICOs may begin accepting enrollment from full dual eligible individuals aged 21-64 after January 1, 2013 for coverage beginning April 1, 2013. For individuals who do not elect to enroll in a plan, MassHealth will conduct passive enrollment in two periods: July 1, 2013 and October 2, 2013. Individuals will have the ability to opt out of the demonstration prior to the passive enrollment taking effect. They will also retain the right to disenroll or switch plans on a month to month basis at anytime during the year. For More information Read the Massachusetts MOU.Read a summary of the Massachusetts MOU from the National Senior Citizens Law Center. Read Medicare Rights’ recent testimony on duals. -Adapted from: Medicare Questions for the Candidates, Medicare Watch, Volume 3, Issue 34, The Medicare Rights Center, September 06, 2012.
Health Care Providers to Launch Insurance Co-Op Program Tufts Medical Center, its network of physicians and Vanguard Health Systems, the parent company of MetroWest Medical Center and Saint Vincent Hospital, announced recently they are sponsoring a new cooperative health insurance model that has received an $88.5 million loan from the federal government. The program, dubbed the Minuteman Health Initiative, is the first in the state. The nonprofit program will be governed by its members and will increase transparency while keeping costs low, program officials said. Any surpluses from the plan, which will be offered through the state Health Insurance Connector and through brokers, would be put back to the collective system to lower premiums or boost coverage, according to the release. Minuteman has to receive approval from the Massachusetts Division of Insurance, but hopes to start operations no later than January of 2014, a requirement of the loan. -See the full MetroWest Daily News article… Little Mentioned on Trail, Poverty Widening in US With nearly one in every six Americans now living in poverty, advocates for the poor say little attention is being paid to the issue and express concern over how this fall’s elections could influence government programs meant to aid the poor. “The political visibility and influence of the poor is now about where it was in the early 1960s, before the war on poverty. If either (candidate) plans to address poverty, they clearly expect to do it below the radar,” said Christopher Jencks, a professor of public policy at the Harvard Kennedy School. The Romney campaign argues that controlling government spending and cutting tax rates for top earners will stimulate the economy and create jobs, particularly for the poor. “It’s clear that if the economy has a reasonable recovery, nobody doubts the rate of poverty would come down,” said Jencks. It won’t necessarily help the poor who have jobs but are paid minimum wage. Nor will it help the job prospects of the disabled, the low-skilled or uneducated, he said. While arguing that the White House is taking the right course by resisting most of the spending cuts pushed by Republicans, advocates for the poor say Obama and Democrats should be more aggressive in trying to lift people out of poverty. -See the full The Boston Globe article…
Leaving an Impoverished Area Increases Well-being In the mid-1990s, thousands of families living in public housing, including nearly 700 adults from some of Boston’s poorest neighborhoods, took part in a federal housing voucher program designed to determine whether moving families to a less impoverished place would improve their lives. The bold social experiment, called Moving to Opportunity , was intended to put a theory about poverty to the test, using the same kind of rigorous study that is the gold standard in medicine. Now, a new analysis by a team of social scientists suggests that while the $80 million program did not lift people out of poverty, it made a profound improvement in their happiness. People given vouchers to move to neighborhoods with less poverty also experienced improvements in mental health and a strong suggestion of benefits to physical health. Their household incomes did not improve, however. -See the full The Boston Globe article… In his speech at the Republican convention, Paul Ryan’s big lie— and, yes, it deserves that designation — was his claim that “a Romney-Ryan administration will protect and strengthen Medicare.” Actually, it would kill the program. But back to the big lie. The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem. Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs. Wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs. -See the full Paul Krugman The New York Times opinion piece… -Cited in/linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, August 31, 2012. Ban is Lifted on Free Meals for Massachusetts Doctors Drug and medical device makers once again can treat Massachusetts doctors to meals and drinks in restaurants, under new regulations that weaken the state’s strict ban on gifts to health care providers. The state Public Health Council approved the emergency regulations this month. In July, Governor Deval Patrick signed a state budget that scaled back restrictions imposed in 2008 and allowed companies to pay for modest meals and refreshments for doctors as part of informational sessions about their products. Note that while the state law has changed, Partners’ policy still prohibits such meals as well as all other gifts to Partners individuals from all pharmaceutical and biomedical companies as well as from any companies that are vendors or potential vendors of Partners. For more information on Partners policy on gifts, see the Office for Interactions with Industry web site , or call John Belknap, MGH director of Corporate Compliance, at 617-724-9725. -See the full The Boston Globe article… Opinion: Dramatic Rise in Drug Prices Greeted With Silence -- Why? We have seen a peculiar phenomenon as the fight heats up over the Affordable Care Act in that the pharmaceutical industry, the most profitable industry in the United States, is sitting it out. Why is that happening? You can say it is because they are going to sell more pills, but why is industry taking this role of supporting what the Chamber of Commerce and a lot of other industries do not like? In summary, it appears that a deal was forged early on in the politics of healthcare reform to leave pharma alone and let them do what they wish with prices. Now we have this ridiculous phenomenon that I have been watching in my practice where the most common drugs have doubled, tripled, or quadrupled in price in the last 3 or 4 years and no one has said anything about it. Why are our professional societies not saying something? Why is the government not saying anything? -See the full Medscape.com opinion piece…
Non-Pharma, In-Home Therapies Decrease Dementia Symptoms Nonpharmacological interventions administered in a home setting can significantly lower the severity and frequency of behavioral and psychological symptoms in patients with dementia, new research suggests. In addition, the metaanalysis showed that the interventions also improved reactions by the caregivers to these often stress-inducing symptoms. "Behavioral and psychological symptoms occur in over 90% of people with dementia at some time during the course of their illness, [which] are very distressing for caregivers and the persons with dementia themselves," lead author Henry Brodaty, DSc, professor of aging and mental health and director of the Dementia Collaborative Research Center at the University of New South Wales in Sydney, Australia, and director of aged care psychiatry at Prince of Wales Hospital, told Medscape Medical News. Some of the elements comprised within the interventions included the following:
-See the full Medscape article summary… Risk for Substance Abuse in Patients with Cancer Pain More stringent screening and monitoring is recommended for cancer patients receiving opioid therapy for pain because of their risk for substance abuse, a new study suggests. Researchers report finding evidence of addiction, including illicit drug use, double doctoring, and drug diversion, among a small group of cancer patients. Traditionally, cancer patients were not considered at risk for opioid or other substance abuse, given their short life expectancies, said the study's lead investigator Osama Alabdulhadi, MD, a neuroanesthetist at Dhahran Health Center in Dhahran, Saudi Arabia. Referral to a pain psychologist is perhaps the "best tool," Dr. Alabdulhadi added. Their findings were presented at the International Association for the Study of Pain 14th World Congress on Pain. -See the full Medscape article summary… Movies and other forms of popular entertainment often present misinformation about and negative portrayals of schizophrenia, which can lead to confused public opinion, new research suggests. In a review of more than 40 contemporary movies that depict characters with schizophrenia, researchers found that most of the characters showed violent behavior, almost one third showed homicidal behavior (even though patients are more likely to be victims of violent acts rather than the ones who carry them out), and one fourth committed suicide. Movies the lead author, Patricia R. Owen, PhD, recommended as showing a realistic and sympathetic representation of the disorder include The Soloist, Canvas, and Some Voices, with Daniel Craig. She also suggested Clean, Shaven — but as a teaching tool and not for the general public. -See the full Medscape article summary… Opinion: Sexual Autonomy for Nursing Home Residents A recent paper argues that people in nursing homes ought to have the right to have sexual relations and that this is not something that doctors bring up with either the patients or the families when someone is getting ready to go to long-term care. One of the big problems is that nursing homes are set up to afford people very little privacy for legal and safety reasons. There are almost always double rooms and it is hard to lock a door. There is no place to go. When you are talking about this with a patient or a family, you first need to broach the idea that romance might still be in the cards. Second, you have to talk to the administrators and see how they handle this sort of thing. Can they find a private spot? Can they lock a door? What is the attitude of the organization and the institution? All of these should be discussed. -See the full Medscape opinion piece… Social Isolation Important and Under-Assessed in Public Health Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to numerous detrimental health conditions. With a high prevalence, and an increasing number of older persons, social isolation will impact the health, well-being, and quality of life of numerous older adults now and in the foreseeable future. For this review, a series of literature searches of the CINAHL, PsycINFO, and Medline databases were conducted for the period of 1995–2010. The results show that there is an overabundance of evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation. However, there is scarce evidence that public health professionals are assessing social isolation in older persons, despite their unique access to very socially isolated, homebound older adults. Additionally, few viable interventions were found; therefore, it is advisable to focus on the prevention of social isolation in older adults. Public health professionals can take steps toward increasing the early assessment of social isolation and referring at-risk individuals to available community resources in order to prevent social isolation or further isolation, which would serve to reduce the numerous negative health outcomes associated with this condition. -See the full Medscape article summary…
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