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MGH Community News |
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MGH Community News |
| January 2013 | Volume 17 • Issue 1 |
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. |
Changes to Child Care Resource and Referral Agencies (CCR&Rs) Effective January 1, 2013, the Department of Early Education and Care (EEC) implemented reforms to the requirements of Child Care Resource and Referral (CCR&R) contracted agencies. The EED recontracted with the CCR&Rs in July through September 2012. Some CCR&Rs will discontinue child care services and others will change their service areas. One of the effected agencies was the Child Care Resource Center (CCRC) in Cambridge. According to their website, they decided not to apply under the new contract proposal. They provided service through December 31, 2012 and then ceased most family service and provider support. CCRC will continue to manage a few local projects through June 2013 and will cease all operations entirely shortly thereafter. Towns formerly covered by CCRC have been reassigned. See: CCRC Towns- realignment: http://www.mass.gov/edu/birth-grade-12/early-education-and-care/financial-assistance/financial-assistance-for-families/ccr-and-rs/ccrr-transition-communications.html. To find a local child Care Resource and Referral Center use the EEC’s Child Care Search at http://www.eec.state.ma.us/ChildCareSearch/CCRR.aspx -Adapted from: DTA Transitions December 2012,forwarded by housingbenefits@googlegroups.com on Behalf Of Kelly Turley, Mass. Coalition for the Homeless, December 28, 2012 and statement from from CCRC website: http://www.eec.state.ma.us/ChildCareSearch/CCRR.aspx/ |
New Social Security Online Services Michael J. Astrue, Commissioner of Social Security, recently announced the agency is expanding the services available with a My Social Security account, a personalized online account that people can use beginning in their working years and continuing throughout the time they receive Social Security benefits. |
More than 60 million Social Security beneficiaries and Supplemental Security Income (SSI) recipients can now access their benefit verification letter, payment history, and earnings record instantly using their online account. Social Security beneficiaries also can change their address and start or change direct deposit information online. Social Security beneficiaries and SSI recipients with a My Social Security account can go online and get an official benefit verification letter instantly. The benefit verification letter serves as proof of income to secure loans, mortgages and other housing, and state or local benefits. Additionally, people use the letter to prove current Medicare health insurance coverage, retirement or disability status, and age. In addition, the portal also includes links to information about other online services, such as applications for retirement, disability and Medicare. For more information or to sign up for a secure account go to: www.socialsecurity.gov/myaccount. -See the full press release.
MGH Service Animal Policy Updated As Zary Amirhosseini, MGH Disability Program Manager, recently reported in Social Service staff meeting, the MGH Service Animal policy has been recently revised. In addition to reminding staff that service animals are welcome, the policy clarifies who is responsible for the care of service animals when on hospital premises. It also clarifies what questions staff can ask to ascertain if an animal is a pet or service animal:
Some new information includes:
Appendix C also lists agencies who can provide care to the service animal if the patient has no family or friends who can do so. The cost would be borne by the patient. See the MGH Service Animal Policy. Questions, or for assistance for any patient with a disability, can be referred to Zary Amirhosseini, MGH Disability Program Manager via e-mail or at 617-726-3370.
Same Sex Married Couples Who Apply Now May Get Retroactive Social Security Benefits if DOMA Overturned An October 2012 report from GLAD (Gay and Lesbian Advocates and Defenders) entitled Social Security and the Defense of Marriage Act: Can I Do Anything Now to Preserve My Rights? encourages certain same-sex married couples to consider applying now for Social Security benefits to which they’d be entitled if their marriages were recognized under federal law. At present, the Defense of Marriage Act Section 3 (“DOMA”) erases the marriages of same-sex couples for all federal purposes. DOMA means that a person married to someone of the same sex cannot claim the Social Security benefits that might be due to a spouse, including:
DOMA also can limit a child’s access to Social Security benefits. For example, when a married working parent dies, DOMA means that a child of the marriage may be denied benefits unless the worker is that child’s birth or adoptive parent or the family lives in a State where the child could inherit from that parent under the State’s intestacy law (this should include all States that permit same-sex couples to marry and Washington, D.C. as well as States that recognize marriages of same-sex couples from other states). GLAD is challenging the constitutionality of DOMA in two separate lawsuits. In addition, efforts are ongoing to repeal DOMA. Those disqualified by DOMA can apply for Social Security benefits now to preserve their rights and possibly receive benefits based on the date of application if DOMA is ruled unconstitutional. Because the administrative appeal process is lengthy (commonly taking years), it is likely that those who apply soon would still be in that process if DOMA is ruled unconstitutional. To qualify one must be married and living in a state that recognizes same sex marriage, the District of Columbia or any foreign country. More Information:
Free Tax Preparation Assistance Those with income of $50,000 or less, or who are age 60 or older, or have a disability or have limited English proficiency, may be able to get free one-on-one tax preparation assistance for federal and state returns at a VITA (Volunteer Income Tax Assistance) site or TCE (Tax Counseling for the Elderly) AARP Tax-Aide site. Volunteer tax preparers at these sites are certified by the IRS. Most sites can e-file tax returns for free. It is important even for those who may not owe taxes to file as low-income people may be eligible for the Earned Income Tax Credit, Child Tax Credit and tax credits for the elderly. The Earned Income Tax Credit (EITC) is a “refundable tax credit” for working, low-income individuals and families. Even workers whose earnings are too small to owe income tax can get the EITC, but one must file a tax return to get the credit. Massachusetts also has an Earned Income tax credit (EIC). The EITC lifts more low-income families out of poverty than any other benefit program. VITA and TCE sites are located in community centers, libraries, churches, shopping malls, retirement homes, and similar locations. Sites are open during the tax season, usually from January through April. To find a free VITA or TCE tax preparation site:
Some sites require an appointment, while others have walk-in hours. See also What to bring with you to the site from the DTA, or Important documents to bring from the AARP. Other tax assistance options include free file software and free file fillable forms. . Healthgrades: Hospital Outcomes Ratings Healthgrades, a healthcare quality reporting group, this month released a list of 262 hospitals that represent the nation's elite when it comes to risk-adjusted mortality and complication rates for 27 common procedures and conditions involving Medicare patients. These hospitals, the top 5% of the nearly 4500 graded by the group, posted mortality rates for 18 procedures and conditions from 2009 through 2011 that were 30.9% lower than those for all the others. If the remaining 95% of the hospitals had performed just as well during this period, more than 164,000 Medicare patients might not have died, according to Healthgrades. Some hospitals score high on patient safety in a few specialties, but the institutions that earned the group's Distinguished Hospitals Award for Clinical Excellence excel across the board, Healthgrades said in a news release. Different Methodologies Yield Different Rankings The Healthgrades list of 262 Clinical Excellence hospitals omits some well-known institutions that dominate other ratings. Massachusetts General Hospital in Boston and John Hopkins Hospital in Baltimore, Maryland, were first and second in the top 17 hospitals, as judged by US News & World Report last year. However, these 2 big names and 11 others on the magazine's list do not appear in the Healthgrades roll call. In another example of contrary rankings, the University of California Ronald Reagan UCLA Medical Center in Los Angeles received a failing grade on patient safety last year from the Leapfrog Group, a quality-improvement organization, only to earn a Clinical Excellence award from Healthgrades this year. Evan Marks, executive vice president for informatics and strategy at Healthgrades, stressed that Healthgrades relies solely on objective clinical outcomes data, in contrast to the US News & World Report ranking, which factors in a hospital's reputation. Furthermore, Healthgrades confines itself to mortality and complication rates, whereas Leapfrog looks at a far broader array of safety measures. The list of the Clinical Excellence hospitals is available at the Healthgrades.com. -See the full Medscape article ...
Fundraising Websites for Individuals To the frustration of social workers, resource specialists, and patients/families alike, some patients are truly in need, but do qualify for help from public benefits or other community resources. With no other options open to them, these patients may need to ask family, friends and acquaintances for help. Sometimes even strangers, given the chance, may want to contribute. A number of internet sites are available to help patients fundraise. One we found, YouCaring.com, purports to be mainly free, only passing on fees from pay processing services like PayPal. Other fundraising sites offer similar services and charge a percentage of the proceeds; in our review fees were typically around 3-5%. Patients and families seeking to fundraise should carefully read the fee schedules and other terms of service for these sites. Here is a sampling (in no particular order):
Another Model- Online Grant Requests ModestNeeds.org is another internet based resources that works somewhat differently- using more of a “crowd sourcing” and unrelated donor model. One applies and ModestNeeds vets the application, after which it is shared on the site. Donors don’t directly fund a specific application. Instead, donor contributions in response to an application are like a “vote” that helps ModestNeeds determine whether to fund the application, and in what order compared to other applications. From their website: ModestNeeds typically seeks to help normally self-sufficient, but low-income households from entering the cycle of poverty by helping them afford short-term emergency expenses. For example, the Self-Sufficiency grant may be used to help a low-income but otherwise self-sufficient household to afford:
Mentoring for LGBT Youth with Disabilities As a dual minority, LGBT youth with disabilities often are confronted with a frustrating conundrum: they do not feel fully included in either the LGBT or disability communities, yet they are at an even greater risk for bullying, prejudice, and depression than their single-minority peers. In fact, these youth can experience prejudice from within their own identity groups. According to one source, "Often... disabled people, including adolescents, are perceived as having no sexual feelings or needs" (Lesbian, Gay, Bisexual and Questioning Youth-Special Populations). Because of the belief that those with disabilities are asexual, many in the heterosexual and LGBT communities discount the sexual identities of youth with disabilities. This results in further alienation of LGBT youth with disabilities, this time from a group they should be able to look to for support. In addition to all these pressures, youth may encounter challenges integrating their various identities. LGBT youth with disabilities might feel the need to choose between a disability and sexual identity, may feel anxious about identifying with yet another socially stigmatized group, or may not feel fully accepted by those same groups (Lesbian, Gay, Bisexual and Questioning Youth-Special Populations). This is where Mentoring comes in. While mentoring is beneficial to all youth, it can have a dramatic impact on youth pushed to the margins of society. According to the assistant attorney general, Laurie Robinson, "...through mentoring organizations, youth are provided with programs that help keep them in school, out of trouble, and most importantly, put them in direct contact with caring adults who provide crucial support and guidance." Partners for Youth with Disabilities provides a mentor program for youth with all disabilities, ages six to 24, and residing within 128. In their mentor training program, for example, they discuss ways in which a mentor can help their mentee with disclosure of their disability: picking the right situations, creating and practicing a script, and encouragement through the whole process. This same process can easily be applied to the "coming out" stage in the life of a young LGBT person. Likewise, bullying is a very pressing issue in both communities, so having a trusted adult there for support and encouragement is even more important for LGBT youth with disabilities. More about the Partners for Youth with Disabilities Mentor Match program: http://www.pyd.org/mm -Adapted from Mentoring for LGBT Youth with Disabilities By Danya Holtzman and Alex Freeman, SRH Disability Issues, Vol. 33, No. 1 (Winter 2013), January 03, 2013. Massachusetts Senior Legal HelplineThe Massachusetts Senior Legal Helpline provides free legal advice, information, and referrals to Massachusetts seniors age 60 or older. The Senior Legal Helpline is for non-criminal legal issues such as Social Security, MassHealth, housing and utilities, nursing homes, guardianship, consumer debt, and similar problems.
The Helpline is a joint project of the Massachusetts Office of Elder Affairs, the Legal Advocacy and Resource Center (LARC), and the Massachusetts legal services community. -Adapted from: http://www.massresources.org/legal-help-online.html#seniorhelpline (Site no longer operational). Free Diapers for Low Income Families Diapers can be a major expense for low income families with babies or toddlers. Money to pay for diapers must come from the family's budget, because diapers are not covered by WIC, and are not an allowed purchase with SNAP (food stamps) benefits. Some of the diaper-related challenges low-income families face:
Families that need diapers and can't afford them may be able to get free diapers from diaper banks and other free diaper programs.
On January 23, 2013, Panera opened its latest Panera Cares café in Boston near the Government Center T station, across from City Hall. Panera Cares is a pay-as-you-wish café--there are no set prices for the meals, just suggested donations. Customers may pay more, less, or nothing depending on what they can afford. Those who can afford to pay a little more will help cover the costs of those who cannot contribute. Those who cannot afford to pay but would like to give back may volunteer an hour of their time cleaning tables, sweeping, and performing other “front-of-the-house” roles. Any additional donations received after covering direct operating costs will be used to develop other programs to serve the community. Panera Cares sites in St. Louis, Detroit, and Portland use their surplus donations to offer job-training internship programs for at-risk youth. Boston is the fifth city to open a Panera Cares café; there are other locations in St. Louis, Detroit, Portland (OR), and Chicago. For more information: http://paneracares.org/ Location:
MassHealth Adult Dental Now Covers Some Composite (White) Fillings Thanks to advocacy efforts, as of January 1, 2013 coverage for composite (white) fillings for the six top and six bottom teeth at the front of the mouth has been restored for adult MassHealth and Commonwealth Care Type 1 members. Fillings for back teeth (premolars and molars) are not covered. -Adapted from Oral Health Advocacy Taskforce - Governor's Budget is Out!, Courtney Chelo, Health Care for All, MA, January 24, 2013. Prescription Advantage 2013 Cost Sharing Updates New deductibles, co-payments, and annual out-of-pocket spending limits for Prescription Advantage went into effect January 1, 2013. For a complete rate schedule, see Prescription Advantage Rate Schedule (January 2013) (MassResources.org website no longer operational). Side 1 lists rates for those with Medicare and Side 2 list rates for those without. -Adapted from January News from MassResources.org, January 29, 2013 . New Medicare Law Eases Access to At-Home Infusions President Obama recently signed a new law that would make it easier for Medicare beneficiaries with immune diseases to receive intravenous immune globulin (IVIG) infusions at home. The law, known as the Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (or Medicare IVIG Access Act), creates a three-year demonstration project that provides the additional Medicare Part B coverage. While prior laws have allowed Medicare to cover the costs of at-home IVIG infusions, the Medicare IVIG Access Act goes a step further to also cover the materials necessary for providers to give beneficiaries the infusions at home. Before the Medicare IVIG Access Act, beneficiaries who could not afford the out-of-pocket costs of at-home infusions would need to go to a hospital to seek care. Read the full text of the law. -Adapted from“ Simplifying Transitions to Medicare” , Medicare Watch, The Medicare Rights Center, January 17, 2013. Medicare Reminder - Part D Transition Rights The Centers for Medicare and Medicaid Services (CMS) requires that Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary, file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan. In early 2013, transition rules will be particularly important for low income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications. All plans change their formularies each year, however, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements. CMS Minimum Transition Requirements CMS requires Part D plans to establish transition policies that cover beneficiaries when they:
Or
For all enrollees: Plans must provide a one time fill–30 day supply (unless a lesser amount is prescribed) — of an ongoing medication within the first 90 days of plan membership.
Plans must mail a written notice explaining that the transition supply is temporary, including instructions for identifying appropriate substitutes; notice of the right to request a formulary exception; and instructions on how to file an exception request. The notice must be mailed within 3 business days of the temporary fill. If, at the point of sale, a plan cannot determine whether a newly written prescription is for ongoing drug therapy or not, the plan must assume that the prescription is ongoing and apply transition policies. Residents in a long-term care (LTC) facility or other institution get further protections. For CMS Guidance on transition drug supplies, go to Medicare Prescription Drug Benefit Manual, Chapter 6 at 30.4 et seq. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Chapter6.pdf. -See full article from the National Senior Citizens Law Center: http://www.nsclc.org/index.php/2013-transition-rights-to-medications-under-part-d/ Medicare Reminder: Part B Late Enrollment Penalties Medicare imposes a 10 percent Part B premium penalty for each 12-month period one delays enrollment in Medicare Part B. “Delaying” means beyond the initial eligibility/sign-up period and only applies if one does not have insurance through a current employer (or a spouse’s employer). In most cases that penalty continues for the duration of Medicare B enrollment. Those who are enrolled in Medicare because of a disability, are the exception, they no longer have to pay the premium penalty once they turn 65. Although one’s Part B premium amount is based on income, the penalty is calculated based on the standard Part B premium. The penalty is then added to the actual premium amount. Calculating a Premium Penalty Example: Mr. B turned 65 in 2007, and delayed signing up for Part B until 2013 (and he didn’t have employer insurance that allowed him to delay enrollment). Because he delayed enrollment for 6 years, his monthly premium would be 60 percent higher for as long as he has Medicare (6 years x 10 percent). Since the Medicare Part B premium in 2013 for most people is $104.90, his monthly premium including the added penalty would be $167.84 ($104.90 x 0.6 + $104.90). Learn more about the Medicare Part B late enrollment penalty at www.medicareinteractive.org. -Adapted from Message to Congress: Restore Medicare Drug Rebates, Medicare Watch, Volume 4, Issue 2 , The Medicare Rights Center, January 10, 2013. Available at: http://www.medicarerights.org/issues-actions/medicare-watch.php
Mass Medical Marijuana Listening Sessions Massachusetts health officials have set aside three days in February for public “listening sessions” as they craft highly anticipated medical marijuana regulations. Under the November ballot referendum that legalized medical marijuana, the Massachusetts Department of Public Health is required to issue regulations on implementing the law by May 1. The department is seeking input on several specific issues including the criteria for deciding which types of conditions patients must have to be authorized for medical marijuana use; security requirements for treatment centers; defining the quantity of marijuana that constitutes a 60-day supply; criteria for the use of marijuana in food products for medical purposes; and the requirements for people who apply to cultivate their own marijuana because of financial hardship or lack of reasonable transportation to a dispensary.
Written comments will be accepted through Feb. 28, at the Department of Public Health, Attention: Medical Marijuana Listening Sessions, 250 Washington St., 2d Floor, Boston, MA 02108. A Frequently Asked Questions document on the DPH role in implementing regulations to support the law can be found at: www.mass.gov/eohhs/docs/dph/quality/drugcontrol/medical-marijuana-faq.pdf. -See the full Boston Globe article ... -See the full Medical Marijuana in Massachusetts website. Repairing the Mental Health System: A Call to Action in the Wake of the Newtown MassacreIn the aftermath of the tragic death of 26 people (including 20 children) in Newtown, Connecticut, on December 14, 2012, much needed attention is being paid to mental health care in the United States. Additional stress on the system has resulted from major disasters like Hurricane Sandy and the recent wars, which have severely taxed civilian and service populations, further affecting already limited psychiatric resources. Unfortunately, those in need of psychiatric care often have very poor access to appropriate management due to lack of resources; others don't seek out care due to real or perceived societal stigma. Together, these barriers represent a major inadequacy in US mental health care. Medscape recently spoke with psychiatrists Richard H. Weisler (UNC-Chapel Hill and Duke University Medical Center), Henry A. Nasrallah (University of Cincinnati College of Medicine and University Hospital), and Joe Parks (Missouri Institute of Mental Health) about the status quo of mental health care in the United States and what can be done to repair the system. Topics include the worsening lack of psychiatric resources, whether “Obamacare” will be good for mental health, closer collaboration with medical colleagues, gaps in research and advocating for more funding among other topics in a wide-ranging discussion. -See the full interview Repairing the Mental Health System: A Call to Action in the Wake of the Newtown Massacre, Bret Stetka, MD, Richard H. Weisler, MD, Joseph J. Parks, MD, Henry A. Nasrallah, MD, Medscape Psychiatry, Jan 22, 2013. Readmission Penalty Hits Safety Net & Teaching Hospitals Hard Massachusetts General will forego about 0.5 percent of its Medicare reimbursement in fiscal year 2013 because its readmission rate was higher than what the Centers for Medicare & Medicaid Services (CMS) projected based on the case mix, or medical complexity, of their patients. A research letter recently published online in the Journal of the American Medical Association ( JAMA ) shows that teaching hospitals as well as safety-net hospitals (SNHs) for the poor are more likely than others to incur the penalty, created by the Affordable Care Act (ACA). The reason, coauthors Karen Joynt, MD, MPH, and Ashish Jha, MD, MPH, suggest, may have something to do with the "socioeconomically vulnerable patients" that both types of hospitals serve on a large scale. Of 3282 hospitals, 2189, or 66.7%, are receiving a pay cut under HRRP. "Prior research suggests that differences between hospitals are likely related to both case mix (medical complexity) and socioeconomic mix of the patient population," Drs. Joynt and Jha write. "There is less evidence that differences in readmission are related to measured hospital quality." -See the full summery article: Readmission Penalty Hits Safety Net, Teaching Hospitals Hard. Medscape. Jan 22, 2013.
Cliff Deal Delays 26.5% Medicare Cut, Saves Medicaid Raise The fiscal cliff bill, called the American Taxpayer Relief Act (ATRA) of 2012, that a contentious Congress passed on New Year’s Day has a number of provisions. Here are some health care related provisions you might have missed. Physician Pay Cut Postponed ATRA postpones a 26.5% Medicare pay cut for physicians for 1 year and preserves a hefty Medicaid raise for those in primary care. The 26.5% physician pay cut stems from the 1997 Balanced Budget Act. It included a provision called the Sustainable Growth Rate (SGR) that has been causing havoc with Medicare physician payments since 2002. Congress and the President prefer to repeal the whole thing, but can't figure out how to find the $300 billion to do so, so they keep approving short term, one-year "patches." So the SGR's impact is again delayed for another year, at a cost of $25.2 billion. ATRA freezes Medicare rates for 1 year. Primary Care Physician Hike Retained ATRA does not, however, offset the cost of this "doc fix" by cancelling a Medicaid pay hike for primary care physicians authorized by the Affordable Care Act (ACA). The ACA raises Medicaid rates to Medicare levels for evaluation and management services and vaccine administration. A federal match will cover 100% of the added costs. Family physicians, general internists, pediatricians, and subspecialists related to these fields (eg, pediatric cardiologists) are eligible for the increase which lasts from January 1, 2013 through December 31, 2014. The hope is that the increase will make primary care more accessible. Hospital Cuts Instead, ATRA pays for the doc fix largely by reducing Medicare outlays to hospitals. The American Hospital Association and other hospital umbrella groups denounce this approach as harmful to their institutions and the patients they serve, especially when hospitals face sizable payment reductions from the Affordable Care Act while physicians face no such reductions. CLASS Repealed The law also repeals the Community Living Assistance Services and Supports (CLASS) title of the ACA. Implementation of CLASS had been suspended by the Obama Administration in the fall of 2011. It had been designed to be a new public insurance program for Americans with permanent or temporary disabilities to help them to stay in their communities to avoid institutionalization. In repealing CLASS, Congress established a new Commission on Long Term Care to develop a replacement plan. -See the full articles:
New National Strategy Aims to Transform Attitudes, End Suicides Every year, more than 36,000 people in the United States commit suicide — more than 100 per day — and for every person who dies, more than 30 people make an attempt. Suicide is the 10th leading cause of death in the U.S. In an attempt to bring the rate down, the National Action Alliance for Suicide Prevention, a group created by Health and Human Services Secretary Kathleen Sebelius and former Defense Secretary Robert Gates, released a new national strategy for suicide prevention on Sept. 10. The 2012 National Strategy for Suicide Prevention has 13 goals and 60 objectives for reducing suicide over the next 10 years. Goals include integrating and coordinating suicide prevention activities across multiple sectors and settings — including workplaces, schools, health provider offices and faith-based organizations — and developing effective programs that promote wellness and prevent suicide. The Action Alliance highlighted four priorities to reduce the number of suicides: integrating suicide prevention into health care policies, encouraging change in health care systems with a goal of preventing suicide, changing the way the public talks about suicide and suicide prevention, and improving the quality of data on suicidal behaviors. For more information on the 2012 National Suicide Prevention Strategy, visit www.samhsa.gov/prevention/suicide.aspx. Or see the full article on Medscape.com... Free Health Clinics For Uninsured Thrive In Mass. Massachusetts has the highest rate of residents with health insurance in the country, but that still leaves about 277,000 men, women and children who aren’t sure where to turn when they get sick and often put off care because it costs too much. A loose-knit network of free clinics in churches, synagogues and vacant offices around the state — often run by retired doctors and nurses — is quietly caring for many of these patients. Congregation Beth El in Sudbury hosts one such clinic. A local Stop & Shop stores medicines for the clinic, at no charge. The Massachusetts Medical Society cover the doctors’ liability insurance and MetroWest Medical Center provides free lab work and X-rays. There’s a crew of nurses, interpreters, social workers and a physical therapist — about 35 volunteers on any given clinic night. Despite Mass. Law, ‘Still A Huge Need’ MetroWest Free Medical Program treats up to 60 patients a night and logs about 1,800 visits a year. Men and women come from 20-30 miles away. Many of these patients could receive good care at one of the dozens of community health centers or hospitals in Massachusetts, but some say those institutions are intimidating. The Affordable Care Act is supposed to provide insurance and a consistent doctor for many patients who currently rely on the roughly 1,200 free clinics around the country. But even after the federal law is operating in full force, there may be as many as 26 million people who will still need free care. The lesson from Massachusetts, where a health coverage law has been in effect for five-and-a-half years, is, plan to stay open. -See (or listen to) the full story Free Health Clinics For Uninsured Thrive In Mass., by Martha Bebinger. WBUR, January 22, 2013. Hospitals and Insurers on Hook for MA Health Costs Guess who has to write the state a check for the lion’s share of funding for the newish health costs law? Almost half the money will come from Partners Healthcare and Blue Cross Blue Shield of Massachusetts (see the charts below). A little background: The newish state law that’s supposed to improve health care quality quality and control costs also imposes a hefty fee on some hospitals and insurers (as well as some other “payers”). The law says the surcharge will raise $225 million for distressed hospitals, a prevention fund, electronic medical records and the agency that will bring the law to life. Now we have the first drafts of who will pay and how much. Among hospitals, only the Partners system, Caregroup and Children’s meet the criteria for the fee (the criteria are spelled out in draft regs.). Partners took a $42mil charge, in anticipation, last year. Caregroup and Children’s have told the state they may ask for a reduction, claiming they don’t fit the criteria.
Now the insurers. The top five are:
By the way, the law says insurers can’t increase premiums to cover this surcharge. None of this is set in stone yet. See the proposed regulations that define who has to pay, how these fees were determined, on what grounds hospitals can appeal, and what happens if the state brings in less than $225. The insurers that handle mostly Medicaid patients are questioning whether they should pay a penalty, because the state would essentially be taxing taxpayer dollars. So this is still a work in progress. -Adapted from, and to see or listen to, the full article: It’s Time To Pay Up For Mass. Health Costs Law, by Martha Bebinger, Commonhealth blog, WBUR, January 17, 2013.Cited in/linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, January 18, 2013.
Income Tax Cuts and The MA Budget Deficit Once again in FY 2014, Massachusetts will face a significant budget deficit. Massachusetts Budget and Policy Center has released a new factsheet on Income Tax Cuts and the Budget Deficit in Massachusetts. It describes the long-term cost of the income tax cuts enacted between 1998 and 2003 as well as other changes that have reduced state tax revenues and lead to significant program cuts. There are two basic reasons that Massachusetts continues to face persistent deficits.
Beginning in 1998, a number of significant changes were made to the state tax code, including a series of phased cuts to the state personal income tax. These cuts played a major role in reducing taxes, along with the capacity to fund essential services in the Commonwealth. Three of these income tax cuts were particularly costly to the Commonwealth: 1) a cut from 5.95 percent to 5.3 percent in the tax rate applied to wage and salary income, 2) a cut from 12 percent to 5.3 percent in the tax rate applied to dividend and interest income, and 3) a doubling of the value of the personal exemption from $2,200 to $4,400 for single filers and from $4,400 to $8,800 for married couples. The combined effect of these three cuts is now a loss of some $2.5 billion in annual revenue. Other factors also have affected state revenue collections in the years since 1998. These include state-level tax policy decisions, along with other, related issues. While there also have been several tax increases over this period—most recently to the state sales tax—the net effect of all increases and reductions since 1998 is that total tax revenue as a share of state personal income has declined by one percentage point (from 6.3 percent in FY 1998 to 5.3 percent in FY 2012). This amounts to a loss of $3.8 billion in annual tax revenue for the Commonwealth. This substantial decline in revenue has produced an ongoing fiscal crisis for the Commonwealth—and severe shortfalls during economic downturns. In response to these budget shortfalls, state lawmakers have made deep cuts to program areas across the budget. -See the full fact sheet: Income Tax Cuts and the Budget Deficit in Massachusetts , Mass. Budget and Policy Center, January 10, 2013 . Patrick Targets Public Housing Authorities Governor Deval Patrick has proposed eliminating the state’s troubled patchwork of 240 public housing authorities and replacing them with six regional agencies in an effort to eliminate waste and corruption from the housing program for low-income and elderly people, state officials say. Patrick’s proposal, which is sure to be controversial on Beacon Hill, would consolidate public housing management into six central offices, while leaving a corps of managers and maintenance workers at local housing authorities. For decades, housing authorities have been run like separate fiefdoms in each town or city, each with its own board and a chief often selected for political rather than managerial skills. As the Globe reported in October, critics say that a significant part of the public housing problem in Massachusetts is the huge number of housing authorities, making it difficult for poor and elderly people to navigate the system while straining the leadership talent pool. Only the state of Texas has more housing authorities than Massachusetts. The overhaul, if passed by the Legislature and signed into law, would shift ownership, governance, and management of thousands of housing developments across the state on July 1, 2014, from local boards of commissioners to six regional organizations, said Lizbeth Heyer, the state’s associate director of public housing and rental assistance. The regional approach would coincide with another major change: allowing tenants to apply for housing statewide, instead of community by community. “People now interested in housing in 10 places have to fill out 10 applications,” she said. “That’s ridiculous. In the new system, there will be one application, one wait list.” Heyer said officials of the Department of Housing and Community Development, which developed the makeover blueprint, estimate that the reorganization will cost $3 million to $7 million. She said that many times that amount is expected to be saved due to greater efficiencies, better maintenance, and faster unit turnaround when tenants move out, among other steps. -See the full Boston Globe article ... Immigration Reform - Bipartisan Senate Blueprint and Obama ProposalIn the opening moves of what lawmakers expect will be a protracted and contentious debate in Congress this year, a bipartisan group of senators has agreed on a set of principles for a sweeping overhaul of the immigration system. The senators were able to reach a deal by incorporating the Democrats’ insistence on a single comprehensive bill that would not deny eventual citizenship to illegal immigrants, with Republican demands that strong border and interior enforcement had to be clearly in place before Congress could consider legal status for illegal immigrants. A House group is working on a legislation that tracks closely with the Senate proposal. Bipartisan Senate Plan Proposals include:
Obama’s Proposals In a speech in Las Vegas on Wednesday (January 29, 2013) President Obama praised the progress in the Senate, saying proposals so far were "very much in line" with his own principles, and he sought to emphasize common ground on an issue that has confounded Congress repeatedly for more than a decade. White House officials made it clear that on several important details, the president prefers a more liberal approach than the one outlined the by the senators. The President’s plan:
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Amid Gentrification, Affordable Units in Chinatown The $35 million redevelopment of Hong Lok House in Chinatown accomplishes the rare feat of expanding affordable housing in Chinatown at a time when luxury high-rises are popping up across the neighborhood, bringing an influx of wealthier renters. The apartments will rent for less than $500 a month. Completion of the first phase next month will create 32 units for low-income elderly residents, who will move from the old Hong Lok building to a new one next door. The original building, which has fallen into disrepair, will be demolished to make way for another 42 units by spring 2014. Perhaps more noteworthy than the project’s recent progress is the decade long struggle to get it financed, which underscores the extreme difficulty of keeping housing in city neighborhoods affordable to a diverse population. Behind the struggle is a dramatic drop in federal funding for new affordable housing. When Hong Lok opens it will have a three- to five-year backlog of applications from people trying to get a unit. -See the full Boston Globe article ...
Fructose Effects in Brain May Contribute to Overeating Consuming fructose appears to cause changes in the brain that may lead to overeating, a new study suggests. Fructose ingestion produces smaller increases in circulating satiety hormones compared with glucose ingestion, and central administration of fructose provokes feeding in rodents, whereas centrally administered glucose promotes satiety, the authors write. "Thus, fructose possibly increases food-seeking behavior and increases food intake." Their findings are published in the January 2 issue of the Journal of the American Medical Association. JAMA . 2013;309:63-70, 85-86. Abstract Editorial -See the summary article: Fructose Effects in Brain May Contribute to Overeating. Medscape. Jan 02, 2013.
The final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been approved by the leadership of the American Psychiatric Association (APA). In its release the APA announced that the latest edition of the manual will include a restructuring of its 20 chapters "based on disorders' apparent relatedness to one another, as reflected by similarities in disorders' underlying vulnerabilities and symptom characteristics." Some key changes:
-See the full article: DSM-5 Gets APA's Official Stamp of Approval. Medscape. Dec. 2, 2012. APA Answers Criticism of Pharma-Influenced Bias in DSM-5 The American Psychiatric Association (APA) has fired back a strong response to a recent article by the Washington Post questioning the possibility of pharmaceutical industry influence on decisions regarding the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The APA's Board approved the diagnostic criteria on December 1, 2012. The Post article specifically examined relationships with industry sources, including receiving partial income, for members of the DSM-5 Mood Disorders Work Group and the APA's Clinical Practice Guidelines Work Group on major depressive disorders. They also discussed the manual's dropping of the bereavement exclusion, calling that decision a potential "bonanza for the drug companies" and "opening the way for more...to be diagnosed with major depression — and thus, treated with antidepressants." "While speculation is bound to occur, we think it is important to stay focused on the fact that APA has gone to great lengths to ensure that DSM-5 and APA's clinical practice guidelines are free from bias," said David Kupfer, MD, chair of the DSM-5 Task Force, in a release. "Throughout the development of each product, APA established, upheld, and enforced its disclosure policies and relationship limits," said Dr. Kupfer. He noted that no DSM-5 task force or work group member is allowed to have more than $10,000 of his or her annual income to be derived from industry sources, nor are members allowed to hold stock or shares valued at more than $50,000 in a pharmaceutical or device company. "When we established the limits on income from industry sources, we looked to make them more stringent than requirements for staff at the National Institutes of Health, members of advisory committees for the Food and Drug Administration, and most academic departments," Dr. Kupfer said. He added that each member agreed to to continue following these limits as long as they are involved in the development of the manual. "APA has looked to strengthen these policies even further for new clinical practice guidelines in development." Providing "Greater Guidance" DSM-5 will remove the bereavement exclusion from the criteria for major depressive disorder, which will be replaced with cautionary notes for clinicians. Dr. Kupfer told Medscape Medical News that "The exclusion criteria will be replaced by 2 notations — a footnote at the end of the criteria that cautions clinicians to differentiate between normal grieving associated with a significant loss and a diagnosis of a mental disorder, and a note embedded within the criteria that reminds clinicians that major depression and bereavement can coexist." "This provides greater guidance to clinicians to help make this distinction and ensures that it is understood that sadness, grief, and bereavement are not things that have a time limitation to them, as dictated in DSM-IV's bereavement exclusion," he said. The DSM-5 is on track to be published this May. -See the full summary article: APA Answers Criticism of Pharma-Influenced Bias in DSM-5. Medscape. Jan 04, 2013.
The Third Wave of Cognitive Behavioural Therapies: What Is New and What Is Effective? Behaviour therapy has its roots in the 1950s. The characteristic feature of this so-called 'first wave' was a focus on classical conditioning and operant learning. The 'second wave' was characterized by a focus on information processing. Second wave (classical) cognitive therapy is at present the dominant contemporary system of psychotherapy worldwide. The 'third wave' of behavioural therapies is characterized by themes new to behavioural psychotherapies: metacognition, cognitive fusion, emotions, acceptance, mindfulness, dialectics, spirituality and therapeutic relationship. Third wave psychotherapies' comprise a heterogeneous group of treatments, including acceptance and commitment treatment, behavioural activation, cognitive behavioural analysis system of psychotherapy, dialectical behavioural therapy, metacognitive therapy, mindfulness-based cognitive therapy and schema therapy. Several randomized controlled trials, longitudinal case series and pilot studies have been performed during the past 3–5 years, showing the efficacy and effectiveness of 'third wave psychotherapies'. Summary : The third wave of behavioural psychotherapies is an important arena of modern psychotherapy. It has added considerably to the spectrum of empirically supported treatments for mental disorders and influenced research on psychotherapy. The presented methods open up treatment possibilities for patient groups such as borderline personality disorder, chronic depression or generalized anxiety disorder that had received only little specific attention in the past. The available evidence now allows considering all third wave treatments as empirically supported. Curr Opin Psychiatry. 2012;25(6):522-528. © 2012 Lippincott Williams & Wilkins -See the full summary article, including more detailed descriptions and discussions of the highlighted “third wave” therapies at The Third Wave of Cognitive Behavioural Therapies: What Is New and What Is Effective? , Medscape, Current Opinion in Psychiatry.
Some children with an accurate diagnosis of an autism spectrum disorder (ASD) may eventually "outgrow" the diagnosis and have normal levels of overall functioning that are within normal testing limits, new research suggests. The study compared 34 school-age children and young adults with a prior diagnosis of ASD who had achieved "optimal outcome" (no current symptoms of the disorder) with 44 matched individuals with high-functioning autism (HFA) and 34 typically developing peers. Results showed that the first and third groups did not differ significantly on mean test scores of communication, social interaction, face recognition, and most language subscales. Although the optimal outcome group had milder symptoms of social dysfunction than the HFA group during their early developmental years, difficulties with communication and repetitive behaviors were equally severe. Lead author Deborah Fein, PhD, professor in the Department of Psychology and the Department of Pediatrics at the University of Connecticut in Storrs, told Medscape Medical News that the investigators are now reviewing records of the various types of interventions the children received and what (if any) role they might have played. "For an individual child, the outcome may be knowable only with time and after some years of intervention. Subsequent reports from this study should tell us more about the nature of autism and the role of therapy and other factors in the long-term outcome for these children." said Thomas R. Insel, MD, director of the National Institute of Mental Health, in a release. According to the investigators, ASDs "are generally considered lifelong disabilities." "Prior studies have examined the possibility of a loss of diagnosis, but questions remained regarding the accuracy of the initial diagnosis and whether children who ultimately appeared similar to their mainstream peers initially had a relatively mild form of autism," they note. "In most cases, it is a lifelong disability. So what we set out to do was to collect a sample of children who we could really document in a pretty rigorous way." J Child Psychol Psychiatry. Published online January 16, 2013. Full article -See the full article summary: Some Kids 'Age Out' of Autism. Medscape. Jan 23, 2013. FDA Clears TMS Device for Resistant Depression The US Food and Drug Administration (FDA) recently cleared the transcranial magnetic stimulation (TMS) system manufactured by Brainsway Ltd for treatment-resistant major depression. According to a press release posted on the company's Web site, the FDA approval for this indication is "generally broader than the definition given by the company's TMS device rival," presumably referring to the Neuronetics Neuro-Star system, which was cleared by the FDA for the same indication in 2008. In April 2012, and reported by Medscape Medical News at that time, the company released top-line results from a double-blind, multicenter controlled trial showing that its TMS system was safe and effective in this patient population. After 5 weeks of treatment, 30.4% of patients in the active treatment group achieved remission from depression, which was defined as a Hamilton Depression Rating Scale (HDRS-21) score of less than 10. In comparison, 14.5% of the sham treatment control group achieved remission ( P = .0148), according to information released by Brainsway Ltd, developers of the device used in the study. Further, the company reported that there was a significant response to treatment, defined as a greater than 50% decrease from baseline HDRS-21 scores, in 36.7% of patients in the active treatment group vs 20.5% in the control group ( P = .0148). -See the full summary article: FDA Clears TMS Device for Resistant Depression. Medscape. Jan 09, 2013. |