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MGH Community News |
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MGH Community News |
| February 2013 | Volume 17• Issue 2 |
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. |
Sequestration and Public Benefits If Congress doesn't act by March 1, $85 billion of automatic federal budget cuts known as the “sequester” will come to pass. Those cuts would represent the start of $1 trillion in cuts over the next decade. Daniel Werfel of the Office of Management and Budget explained recently in testimony before the Senate Appropriations Committee: "Agencies would be required to implement the cuts over the remaining seven months of the fiscal year, meaning that in many programs the effective cuts would be closer to 9 percent for nondefense programs and 13 percent for defense programs when compared to what agencies would spend during this period under normal circumstances." Programs EXEMPT from sequestration (not a complete list):
Examples of programs that are PARTIALLY EXEMPTED:
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Health and Social Service Programs SUBJECT TO THE CUTS (not a complete list):
Sources and for More Information
Housing Protections for DV Survivors Enacted “An Act Relative to Housing Rights for Victims of Domestic Violence, Rape, Sexual Assault and Stalking,” was enacted by the MA Legislature and signed into law on January 3, 2013 by Governor Patrick. In addition to the challenges of finding safety and maintaining stable housing, victims of sexual and domestic violence often encounter financial and legal barriers if they need to leave their home, even when staying in their home is unsafe. Many victims also face discrimination from prospective landlords when or if a past history of abuse is known. Advocacy materials from the Boston Area Rape Crisis Center (BARCC), provide examples of what many victims face when trying to secure safety after an assault.
The legislation provides victims of these crimes with rights and protections while also protecting the rights of property owners. This new law will provide rights and protections in the following ways:
Details: To vacate a lease or rental agreement without a financial penalty, the survivor must provide “proof of status” documentation to his/her landlord for one or both of the following:
Any of the following can serve as “Proof of Status”:
-See the State’s full press release... Congress Votes to Reauthorize VAWA Hot off the presses: the U.S. House of Representatives voted today (February 28, 2013) to reauthorize the Violence Against Women Act, five hundred days after letting it expire. House Republicans finally caved today and voted to reauthorize the bill, which was first passed in 1994 to help victims of rape and domestic violence find safety, care and justice. President Obama is expected to sign it once it gets to his desk. Since VAWA expired, House Republicans have been resisting the version of the bill that passed the Senate with a vote of 78-22. They objected mainly to expanded protections for LGBT victims, immigrants, and Native Americans. The Act ensures that eligibility for services like shelters and legal help includes abuse victims regardless of their sexual orientation or immigration status . House Majority Leader Eric Cantor initially took the lead in objecting to a provision that would allow tribal authorities jurisdiction in some cases where non-Native Americans rape or assault a Native American on tribal lands. House Republicans offered an alternative bill that didn't have these expanded protections, which was voted down this morning before the more expansive Senate version passed. -See the full Slate.com article..
Alzheimer’s Guide: Protect Your Loved One from Wandering The inability to control wandering is what often drives families to decide to place a loved one in a nursing home. However, there are some simple measures to prevent wandering that often work well for a time and can even help postpone that difficult decision. The Alzheimer’s Association recommends these steps:
In addition to these preventive measures, you'll want to take some additional precautions so you're prepared if wandering does occur.
-See the full article: Alzheimer's guide: Protect your loved one from wandering, Healthbeat, Harvard Medical School, February 09, 2013. ReServe: Nonprofit Puts Seniors to Work Helping Other People ReServe Inc., a nonprofit that puts adults age 55 and up to work in schools, government offices, and community agencies opened its doors in Boston recently. The program matches people — often recent retirees or unemployed older workers — with part-time jobs, paying them a $10 an hour stipend for their help. Foundations and private donors have funded the concept in seven cities — including Miami, Milwaukee, and now Boston — because it is a unique way to capitalize on the skills and energy of an aging baby boomer population in an era of reduced public funding for social programs. ReServe began in Brooklyn in 2005 when two entrepreneurs, veteran New York Times editor Jack Rosenthal, who had covered older Americans’ efforts to stay active, and social service advocate Herb Sturz came up with the idea for the program and opened its first office. Since that time, ReServe has placed about 3,000 workers, known as “ReServists,” in more than 350 organizations. Participants may work as tutors in schools and libraries or act as college counselors helping low-income students track down and apply for scholarships in schools where staff may be overburdened with other duties. Other ReServists might work in a hospital setting, McMahon said, helping patients and hospitals navigate new federal health care rules. Jewish Vocational Service helped bring the program to Greater Boston, conducting a feasibility study and eventually securing a $162,000 grant from the Tufts Health Plan Foundation and other donations. Officials at Greater Boston ReServe, which will operate out of Jewish Vocational Service’s office on Winter Street, want to place 25 people in jobs this year, 50 next year, and 100 in 2015. More information at www.reserveinc.org/greaterboston -See the full Boston Globe article ... Pet Food StampsNOTE: this program is no longer in operation. A New York-based nonprofit group is trying to help low-income families around the nation by offering "food stamps" for pets. Pet Food Stamps seeks to aid disadvantaged pet-owners across the U.S. who need help caring for their beloved animals. The program provides free monthly home delivery (for up to six months) of all necessary food supplies to those who qualify- mainly those already receiving Supplemental Nutrition Assistance Program (SNAP - food stamps) or those with income below the poverty line. Many of the approximately 47 million Americans who receive benefits through SNAP have cats and dogs, and they struggle to feed their pets, Pet Food Stamps states on its website. If they cannot afford food, families have been driven to surrender their pets to shelters. But those who qualify for public assistance are likely to qualify for private help from Pet Food Stamps as well. The group is funded through "the generosity of contributors and patrons," according to its website. It provides pet food through a partnership with Pet Food Direct. "It's aimed at preventing people from having to choose feeding themselves or their animals or having to surrender them to a high-kill shelter," Okon explained to New Mexico's KRQE radio. -See the full Huffingtonpost.com article... -See the Pet Food Stamps website
Medicare Reminder- Inpatient Psychiatric Benefits Medicare helps pay for inpatient mental health services in psychiatric hospitals or general hospitals. Medicare benefits have a lifetime limit of 190 days of inpatient care in a psychiatric hospital. After that limit, Medicare may help pay for mental health care at a general hospital. Out-of-pocket costs are the same in a psychiatric hospital as they are in any hospital. If one enters a psychiatric hospital within 60 days of being an inpatient at a different hospital, this is considered the same benefit period covered by the initial deductible. A benefit period ends when one has been out of the hospital or skilled nursing facility for 60 consecutive days. Learn more about Medicare coverage of mental health services at www.medicareinteractive.org. - Adapted from Strengthening Medicare for the Future, Medicare Watch, Volume 4, Issue 5, The Medicare Rights Center, January 31, 2013. Medicare Improvement Standard Case Settlement Approved As reported previously (Medicare Improvement Standard Ending- New Details, MGH Community News, December 2012), a court settlement has been reached to discontinue the practice of routinely halting services such as physical therapy for Medicare patients once the patient reaches a plateau. The court held a Fairness Hearing on January 24, 2013 and the judge approved the settlement. The Settlement confirms, and the government agreed, that skilled services are covered when they are required to maintain a patient’s condition, or prevent further deterioration (and includes services covered under Medicare Parts A and B). With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings. CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve. The Center for Medicare Advocacy believes that the Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now – while CMS works on policy revisions and its education campaign. They encourage people to appeal should they be denied Medicare for skilled maintenance nursing or therapy because they are not improving. For people needing assistance with appeals, the Center for Medicare Advocacy has self-help materials available. This information can help individuals understand proper coverage rules and learn how to contest Medicare denials for outpatient, home health, or skilled nursing facility care. Explain that the Settlement confirms, and the government agreed, that skilled services are covered when they are required to maintain a patient’s condition, or prevent further deterioration. Providers and Medicare decision-makers should be pushed to change their approach based on the Settlement – now. When fully implemented, the Settlement Agreement will result in new manual provisions explicitly covering maintenance nursing and therapy, and formal education of adjudicators and providers. CMS’s education campaign will probably begin in the summer of 2013. -See the full Center for Medicare Advocacy article, plus a detailed Q&A and self-help materials... Medicare Rights Center- Deficit Reduction Fact Sheets In the coming months, Congress will face a series of deadlines—from the imposition of automatic spending cuts on March 1, to the expiration of the federal budget patch on March 27 and the impending debt ceiling this summer. Any one of these deadlines could force the enactment of proposals that affect the future of the Medicare program. According to the Medicare Rights Center, unfortunately, the most discussed proposals would save money in Medicare by shifting costs to people with Medicare, while doing nothing to solve the root problem—high health care costs system-wide. The Medicare Rights Center has posted a collection of web videos, blog posts, press clippings and fact sheets with which they hope to help people with Medicare and their families understand the impact of various Medicare proposals, so they can lend their voice to this debate. -See the "Paying More For Less" Fact Sheet Series at www.medicarerights.org/issues-actions/deficit-reduction.
The RIDE – Fare Increase May Be Leaving Disabled Home-Bound Seven months after MBTA fare increases kicked in, travel on The Ride has declined more drastically than the 10.3 percent drop-off T officials predicted last March. Between July and December of 2012, registered passengers made 934,985 trips on The Ride, a 16.2 percent decrease from the same six-month period in 2011. And though MBTA buses and trains have posted modest -increases in ridership since the fare increase, bucking T predictions, trips on The Ride have steadily declined. Seniors and disabled individuals say the jump in one-way fares from $2 to $4 has forced them to cut back on outings, spend more time at home, and in some instances, scrimp on life-sustaining trips such as grocery shopping and doctor visits. The Ride, a service mandated by the federal Americans with Disabilities Act, has historically been financially draining for the T. On average, each trip costs the state $40, which made the service a prime target for fare hikes last year. Beverly A. Scott, general manager of the MBTA, said T officials anticipated a drop-off in ridership, but are working to find out whether that decline has occurred mostly among those who have been able to find alternate modes of transportation. The Massachusetts Office on Disability and the Executive Office of Elder Affairs are compiling a study that they hope will shed some light on how the fare increases have affected seniors and those with disabilities. -See the full Boston Globe article ..
New Federal Rule Requires Insurers to Offer Mental Health Coverage The Obama administration issued a final rule on this month defining “essential health benefits” that must be offered by most health insurance plans next year The federal rule requires insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse, and other conditions. White House officials described the rule as a major expansion of coverage. In the past, they said, nearly 20 percent of people buying insurance on their own did not have coverage for mental health services, and nearly one-third had no coverage for treatment of substance abuse. The essential health benefits include ambulatory patient services; emergency care; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and rehabilitative services and devices; laboratory services; preventive and wellness services, and chronic disease management; and pediatric services, including dental and vision care. Plans in the individual and small-group markets inside and outside of health care exchanges must cover essential health benefits beginning in 2014. Sources and for More Information
Both of above Cited in/Linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, February 22, 2013. Why Some Families Won't Qualify For Subsidized Coverage Under the ACA The Obama administration adopted a strict definition of affordable health insurance in rules released in January that will deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers. Under the Affordable Care Act (ACA), most Americans will be required to have health insurance starting next year. Low- and middle-income people can get subsidies if they do not have access to “affordable” coverage from an employer. The law specifies that employer-sponsored insurance is not affordable if a worker’s share of the premium is more than 9.5 percent of the worker’s household income. In the recent announcement, the Internal Revenue Service clarified that only the cost of coverage for an individual employee (“self-only coverage”), not for family coverage, would count towards reaching this 9.5 percent threshold. Family coverage might be prohibitively expensive, but federal subsidies would not be available to help buy insurance for children in the family. In 2012, according to an annual survey by the Kaiser Family Foundation, the employee’s share of healthcare premiums averaged $951 for individual coverage and more than four times as much, $4,316, for family coverage. Under the I.R.S. rule, such costs would be considered affordable for a family making $35,000 a year, even though the family would have to spend 12 percent of its income for full coverage under the employer’s plan. Under the law, people who go without insurance will generally be subject to tax penalties. In a separate proposed regulation, the Internal Revenue Service said that the uninsured children and spouse of an employee would be exempt from the penalties if the cost of coverage for the entire family under an employer’s plan was more than 8 percent of household income. Bruce Lesley, the president of First Focus, a child advocacy group, said: “The administration recognizes that the cost of family coverage will be unaffordable for many families. They will not have to pay the penalty. But that will not be much of a consolation to families who cannot get health insurance for their kids.” Kathleen Sebelius, the secretary of health and human services, also recently said that she wanted to use her discretion to prevent the imposition of tax penalties on certain uninsured low-income people in states that choose not to expand Medicaid. A rule proposed by her department would guarantee an exemption from the penalties for anyone found ineligible for Medicaid solely because of a state’s decision not to expand the program. The administration said this was “an appropriate use of the hardship exemption.” Many illegal immigrants, prisoners and members of certain religious groups opposed to the acceptance of insurance benefits will also be exempt from penalties if they forgo coverage, the administration said. Sources and for More Information
Both of above cited in/linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, February 01, 2013. Opinion: A Path or a Roadblock to Citizenship? There is much to cheer in Washington’s rapid re-commitment to immigration reform. But as with any legislation, the devil is in the details. The proposals include a mix of carrots and sticks: tougher enforcement alongside a roadmap to lead undocumented immigrants out of the shadows. Getting the balance right, in a logical sequence, is crucial. For example, both the Senate framework and Obama’s own principles require undocumented immigrants to learn English in order to obtain permanent residency status, the first step on the “path to citizenship.” It’s important that immigrants learn English, for their own advancement as well as for social cohesion. But there are at least 12,000 people on waiting lists for English-learner classes in Massachusetts alone, according to the state’s immigrant advocacy group, MIRA. “The requirement sheds a light on how woefully underfunded our system is already,” said Claudia Green, director of English for New Bostonians, a partnership with MIRA and the city. Another hurdle: Some lawmakers are insisting on secure borders, not only as a companion to the path to citizenship, but as a precondition. That can make the wait unacceptably long. The Obama administration has proven its enforcement mettle: The Migration Policy Institute calculates that the government spent more on immigration enforcement agencies last year ($18 billion) than on the FBI, Secret Service, Drug Enforcement Administration, and Bureau of Alcohol, Tobacco, Firearms, and Explosives combined. In fact, after years of “enforcement first,’’ most of the benchmarks established in previous bills have been met. Deportations have soared under Obama’s administration. And migration into the country has declined so sharply that illegal border crossings are now at net zero, according to the Pew Hispanic Center. “We don’t want to create a semi-permanent underclass of people for whom citizenship is a goal that’s forever moving further into the distance,” said Kica Matos, Director of Immigrant Rights at the Center for Community Change, a Washington advocacy group. The details will determine if this time, immigration reform creates a path to citizenship, or a roadblock. -See the full The Boston Globe opinion piece…
The Trick to Recognizing a Good Whole Grain: the Carb-to-Fiber Ratio What’s the best way to identify a healthful whole-grain food? Use this rule: for every 10 grams of carbohydrate there should be at least one gram of fiber. That’s about the ratio of fiber to carbohydrate in a genuine whole grain—unprocessed wheat. This recommendation comes from a new report from the Harvard School of Public Health published online in the journal Public Health Nutrition. The information needed to do the calculation is easily found on food labels, which list both total carbohydrates and fiber (see illustration). Divide the grams of carbohydrates by 10. If the grams of fiber is at least as large as the answer, the food meets the 1:10 standard. In the nutrition label shown here, for example, one serving of this whole-grain roll has 23 grams of carbohydrate. Divide that by 10 and you get 2.3. It also has 5 grams of dietary fiber, which is definitely bigger than 2.3. That signals a healthful whole-grain food. Why bother eating whole grains? They deliver everything an intact grain has to offer—fiber, vitamins, minerals, antioxidants, and other phytochemicals. As long as they aren’t overprocessed, the body digests them more slowly, which can delay hunger. And large, long-term studies have shown that consuming whole grains is one way to help reduce the odds of developing heart disease, diabetes, and other chronic conditions. Intact grains—wheat berries, oat berries, brown rice, quinoa, and the like—are the best source of whole grains. Ground whole grains come next, as long as they still deliver a good dose of fiber and don’t also deliver added sugar, trans fats, or sodium. -See the full story on the Harvard Health Blog...
Dying Medicare Beneficiaries Increasingly Moved to Hospice Some 42.2% of Medicare beneficiaries died in hospice care in 2009 compared with 21.6% in 2000, according to a large (n=848,303) retrospective cohort study. However, that finding is clouded by the fact that just over a quarter of those using hospice (28.4%) in 2009 did so for fewer than 3 days and 40.3% of them moved to hospice after intensive care unit (ICU) stays. Joan M. Teno, MD, from the Warren Alpert Medical School of Brown University, Providence, Rhode Island, and colleagues report their findings in the February 6 issue of JAMA. Study limitations include its reliance on Medicare claims data, which does not characterize disease severity or patients' preference for care. Because the data were specific to fee-for-service beneficiaries, the study results may not be generalizable for other types of Medicare plans. "Although the [Centers for Disease Control and Prevention] reports that decedents aged 65 years and older are more likely to die at home, our results are not consistent with the notion that there is a trend toward less aggressive care. Between 2000 and 2009, the ICU utilization rate, overall transition rate, and number of late transitions in the last 3 days of life increased," Dr. Teno and coauthors conclude. JAMA . Published online February 6, 2013. -See the full Medscape summary article: Dying Medicare Beneficiaries Increasingly Moved to Hospice, Feb 05, 2013. Training Bystanders to Spot Opioid Overdose Saves Lives Educating and training potential bystanders to recognize opioid overdose may reduce deaths, new research suggests. In the study, almost 3000 potential bystanders in Massachusetts underwent state-supported overdose education and nasal naloxone distribution (OEND) programs. Communities with OEND programs had adjusted death rates from opioid overdoses that were significantly lower than communities without the programs. Leading Cause of Death "Poisoning, nine out of 10 of which are related to drug overdoses, has surpassed motor vehicle crashes to be the leading cause of death by injury in the United States," report the investigators. For this study, they assessed participation in OEND programs, which were implemented in 19 communities in Massachusetts in which at least 5 opioid overdose–related fatalities were reported in 2004, 2005, and 2006. The 10- to 60-minute programs were aimed at "opioid users at risk for overdose, social service agency staff, family, and friends of opioid users." Participants were trained between 2006 and 2009 to recognize and respond to an overdose by notifying emergency personnel, providing rescue breathing, and delivering nasal naloxone (an opioid antagonist) from provided rescue kits. Before receiving an additional naloxone kit, each participant had to fill out a questionnaire regarding their rescue attempts. Full information was available for 153 rescue attempts — 150 of which involved the successful use of naloxone (98%). Of the other 3, those who overdosed survived after receiving ED care. "Two features of the Massachusetts OEND programs that supported broad implementation include the use of a nasal naloxone delivery device and the use of a standing order issued by the health department, which allowed non-medical personnel to deliver OEND," write the investigators. "These features may enable broader implementation with greater impact as more communities implement OEND," they conclude. BMJ. Published online January 31, 2013. Full article -See the full Medscape.com summary article: Training Bystanders to Spot Opioid Overdose Saves Lives. Feb 05, 2013.
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