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MGH Community News |
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MGH Community News |
| July/August 2013 | Volume 17 • Issue 7 |
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. |
FY 14 State Budget – What it Means for Benefits (Also see related stories: MassHealth Dental Fillings Benefit to be Restored, New Resources for Marathon Bombing Victims and Electronic Benefit Transfer (EBT) Card Anti-Fraud Efforts – Including New Photo ID) The Massachusetts fiscal year 2014 began on July 1, 2013. While we started the year without a budget in place, it has since wound its way through the legislative process. Here are some highlights of the budget as it relates to public benefits and health and social services. Human Services The Department of Children and Families(DCF) DCF is essentially level funded after accounting for inflation. Funding for DCF remains 19 percent below pre-recession levels. Language requiring DCF to maintain a timely fair hearing system is included in the budget. DCF is not meeting current requirements with wait times for fair hearings and subsequent decisions being much longer than what is stipulated in regulations. The budget requires DCF to implement new regulations reducing these wait times by September 13, 2013 and will have to submit quarterly reports to the legislature showing how long clients had to wait for fair hearings, appeals and decisions. Elder Services The FY 2014 budget funds Elder Services 6 percent more than FY 2013 spending.
These two programs allow seniors to remain at home instead of living in a nursing home. The legislature projects that the combined increase will be enough to eliminate the need for wait lists in FY 2014. Elder Protective Services receives $22.0 million, a $4.8 million increase over FY 2013. The entire increase is needed for Chapter 257 increases. This service investigates elder abuse and neglect, and provides money management supports to prevent financial exploitation. Transitional Aid to Families with Dependent Children (TAFDC) Transitional Aid to Families with Dependent Children (TAFDC) receives $302.0 million, $13.4 million below FY 2013 and $45.2 million (13 percent) below FY 2001 funding. For entitlement programs like transitional assistance, funding levels are significantly affected by anticipated caseload levels. However, the cash grant available for families has not changed in over a decade and because of inflation is worth almost 25 percent less than in FY 2001. Families, already struggling, have a harder time each year buying necessities with the grant provided under the TAFDC program. The $40 rent allowance and the $150 children's clothing allowances are included. |
Housing The state budget provides housing assistance, including shelter for homeless families, to low- and moderate-income people in Massachusetts. The FY 2014 Budget provides $96.8 million for Emergency Assistance (EA- family shelter). EA's budget for FY 2013 that included supplemental budget allowances over the course of the year was $136.8 million in FY 2013 for a difference of about $40 million. The Fiscal Year (FY) 2014 budget continues the eligibility changes made in FY 2013 that limit low-income homeless families' access to shelter. The Legislature's final budget of $60.0 million for HomeBASE, which provides short-term, housing supports for families who are eligible for EA, is $30.0 million less than the current FY 2013 budget. The budget provides significantly less funding than FY 2013 because over 5,000 families will run out of rental subsidies provided through HomeBASE during FY 2014. When HomeBASE was created in FY 2012, it provided 3 years of rental subsidies for families eligible for EA. Soon after the program opened, demand exceeded funding and the Department of Housing and Community Development (DHCD) closed the multi-year program to new families and only provided one year of rental assistance to new families. It also lowered the duration of assistance provided to the 2,000 original families from three to two years. In an effort to prevent these families from becoming homeless once their subsidies end, the FY 2014 budget provides these families with access to long-term housing supports including MRVP, as well as to short-term assistance through the Rental Assistance for Families in Transition (RAFT) program. Families whose rental assistance ends could also enter EA shelters if they are eligible for the program. DHCD has established a special HomeBASE hotline for those timing out of service to answer questions and address concerns from families, advocates, property owners, and other stakeholders: 617-573-1123. (Families are encouraged to first contact their HomeBASE stabilization worker, but can use this number as a back-up.) While cutting funding for shelter and HomeBASE, the final budget increases funding above the FY 2013 current budget for a number of affordable housing programs including:
For a detailed discussion, please see MassBudget's "Shelter, Housing, and Homeless Policy in Massachusetts." -See the full Mass Budget report ... -Some housing Details adapted from Important Updates: Implementation of Housing and Homelessness Programs After Final Approval of the FY'14 Budget, e-mail from Kelly Turley, Mass. Coalition for the Homeless, July 25, 2013. Health Care Safety Pharmacies, hospitals, nursing homes, and other health care facilities will face greater scrutiny under the FY 2014 budget which includes an additional $1.3 million for pharmacy inspections and an extra $1.2 million for review and inspections of hospitals and other health care facilities. The additional funding for pharmacy inspectors follows a major national public health crisis last year blamed on a Framingham specialty pharmacy. More than 740 people were sickened, and 55 died, in a national fungal meningitis outbreak caused by contaminated steroids. The pharmacy had not been regularly inspected by the state pharmacy board, which is overseen by the health department. Since then, the board has conducted routine, unannounced inspections of 40 similar pharmacies, uncovering numerous problems. Dr. Madeleine Biondolillo, director of Health Care Safety and Quality said the money will allow the department to continue the surprise inspections and expand its oversight. The $1.2 million increase for the safety and quality bureau, which licenses hospitals, nursing homes, and other health care facilities, restores some of the previous reductions to its budget. During the past four years, the bureau has lost about $4.7 million, a 26 percent cut when adjusted for inflation, according to an analysis by the Massachusetts Budget and Policy Center. -See the full Boston Globe article ... New Bureau of Program Integrity The budget creates a new Bureau of Program Integrity to operate within the Executive Office of Health and Human Services (EOHHS) but not under its control. The director of the bureau is to be appointed by the Inspector General, and it will develop and oversee regulations with a focus on improving eligibility determinations and reducing fraud in EOHHS programs. The Transportation Bill The state Legislature voted to override Governor Deval Patrick’s veto of an accompanying $800 million transportation finance bill, concluding months of political wrangling. The money the bill provides will prevent the need for immediate MBTA fare hikes in addition to funding other transportation projects and upgrades. -See the full Boston Globe Article ...
Mass Rehabilitation Commission Home Care Assistance Program (Homemaker) Closed to New Referrals Our staff have been informed that the Mass Rehabilitation Commission (MRC) Home Care Assistance Program (HCAP), which offers Homemaker Service, is currently closed to new referral until further notice (possibly October). HCAP serves those with disabilities who are age 18-59 and meet other eligibility criteria (including financial criteria). HCAP’s Homemaking services are defined as direct assistance with:
For more information see mass.gov. Social service staff can also see Mass Rehab Home Care Assistance Program: HOMEMAKER Services under Services on our Disability page (onthe staff access area of our website). Alternatives Adults with Disabilities (under age 60) who have MassHealth:
Seniors age 55 or older with MassHealth or Dually Eligible (MassHealth and Medicare):
Seniors (60 and older) are not eligible for HCAPContact the local ASAP for eligibility for homemaker services. Eligibility requirements include income requirements (those over-income may qualify for sliding fees) and service need requirements (require assistance with a certain number of Activities of Daily Living and Instrumental Activities of Daily Living). Eligibility for the Home Care Program.Those who are Legally Blind are served by another agency:
Children under age 18 are not eligible for HCAP:
Social Security Now Accepting Claims for Same Sex Benefits and More on Benefits Post-DOMA In its first public announcement since the Supreme Court struck down Section 3 of the Defense of Marriage Act (DOMA), the Social Security Administration (SSA) issued a press release on July 12 stating that it is "taking claims now from individuals who believe they may be eligible for Social Security benefits" and that it will "process these claims as soon as we have finalized our instructions." The National Senior Citizens Law Center (NSCLC) reads the Social Security Act as requiring that these benefits also be made available based on registered domestic partnerships or civil unions if the wage earner is domiciled in a state that recognizes the relationship and if there would be a right to inherit personal property without a will on the same basis as a married couple. It is important that people who think they may be eligible for spousal or survivor benefits based on a same sex relationship apply now since each month that they delay could result in the loss of a month's benefits. Social Security Spousal and Survivor Benefits Social Security was designed to protect workers and their spouses even if the spouse didn’t work. Under the program, if one spouse works and the other doesn’t, the nonworking spouse can get retirement benefits simply by being married to the worker. And if the worker dies first, the nonworking spouse gets 100 percent of the worker’s retirement benefits. Those benefits should soon be available to same-sex married couples. The benefits disappear, however, if both spouses work and earn about the same amount of money over their lifetimes. In this case, both spouses simply get the benefits they earned by working and paying into the system. Medicaid The Medicaid program has very specific eligibility rules for married couples which can be protective in some cases and force the spouse to provide support in others. These include:
Other Benefits Veterans benefits: Spouses of deceased veterans will be eligible to receive veterans benefits. But veterans whose same-sex spouses have significant income may lose benefits they are now eligible for because a spouse's income is counted in determining veterans' eligibility for certain benefits. Supplemental Security Income. Because eligibility depends in part on a spouse's income, some who would have previously qualified as individuals won't be eligible if their spouse has substantial income. Medicare: Married same-sex spouses will now be able to enroll without paying a premium even if they lack the requisite quarters of work history. Federal housing assistance programs. Being married also affects your eligibility for these. NO effect on food stamps. Unusually among income support programs, the Supplemental Nutritional Assistance Program considers only "household" resources without regard to marriage, so there will be no effect on gays' access. COBRA - Same-sex spouses will now be able to access COBRA continuation coverage for health insurance. For a more comprehensive roster of the specific changes that are coming for some gay marrieds, click here. Adapted From, and for More Information:
New Resources for Marathon Bombing Victims Additional Specialized Victim’s Compensation Funds & Home Modification Funds On July 1, the state Legislature passed their FY14 Budget package which updates the state Victim Compensation statute (M.G.L. c. 258C) to provide for additional resources to better assist victims of the Boston Marathon bombings. The Legislature also passed a FY13 supplemental budget that allocates $200,000 to assist victims of the Boston Marathon bombings who have lost limbs or the use of their limbs and require significant home modifications or relocation to a more accessible home because of their injuries. MOVA will provide an update when these benefits become available and how to access them. For further information these programs and all other support services available to victims of the bombings, please see the MOVA website, or contact MOVA at 617-586-1340 or contact the Collaborative Hotline at (855) 617-3863 (more information below). Collaborative Hotline In an effort to continue addressing the ongoing needs of those impacted by the Boston Marathon attack, the Massachusetts Office for Victim Assistance (MOVA), the Boston Public Health Commission (BPHC), One Fund Boston and Attorney General Martha Coakley’s Victim Services Division have joined forces and launch a Collaborative on Monday, August 5 to offer the services of trained specialists to help victims and their families in identifying and accessing programs available to meet their unique needs. Beginning August 5, the Collaborative hotline - (855) 617-3863 - will be staffed by individuals trained specifically to assist those impacted by the attack on the Boston Marathon and the days that followed. This phone number along with plans to co-locate specialists in one office will limit the need for victims to call many different places seeking assistance. The Collaborative will help meet individual needs by connecting them with requested services such as medical, mental and behavioral health, housing, employment, financial planning and insurance programs. Any victim, including families of deceased victims, with questions about resources and services available to them can call and be connected with a trained professional. This new Collaborative will last at least six months as a formal assessment of the long term needs of victims is conducted and a permanent service delivery mechanism is established. One Fund Offers Ongoing Support One Fund Boston intends to continue supporting those most affected by the attacks through events, support groups, and other ways identified as helpful for their future success over the longer term. One Fund Boston will work to establish this longer term operating model through communication with the survivors and families in a manner that will provide for a productive transition from a victim relief fund to a service and support network. -For more information, see the full press release. Electronic Benefit Transfer (EBT) Card Anti-Fraud Efforts – Including New Photo ID At the same time that Governor Patrick signed the FY'14 budget, he also signed a $125 million FY'13 supplemental budget. This supplemental budget includes language requiring the Department of Transitional Assistance (DTA) to issue electronic benefits transfer (EBT) cards with photos for many program participants. There will be exemptions for elders, people with disabilities, and individuals who are survivors of domestic violence. Proponents of adding photo ID to welfare benefit cards argue that it will help reduce illegal trafficking of the cards, but critics suggest it puts a burden on the elderly and disabled who may rely on others to do their shopping. Opponents believe that such a plan will be stigmatizing, difficult and expensive to implement, and is based on little evidence that it will address a significant source of fraud. Opponents also frequently point out that Governor Mitt Romney ended the photo ID program during his administration because the benefits did not outweigh the cost of running the program. In signing off on these sections, the Governor sent back an amendment that would require the Legislature to study the impact of such changes over the course of the next three years to assess its effectiveness. As the implementation of a photo ID requirement will be costly for DTA, the Governor also proposed $2.5 million in additional funds for implementation in a new FY'14 supplemental budget request. High EBT Balances Eliminated Massachusetts officials launched an initiative this month that will eliminate high balances on electronic benefit transfer (EBT) cards and suspend federal nutritional assistance benefits that are not being utilized, as officials continue a crackdown meant to save taxpayers’ money and protect benefits for those who really need them. According to the latest data, collected in March, the average account balance of those receiving cash assistance is $25.21, but six accounts were in violation of department rules and have EBT card balances over $2,500, Stacey Monahan, commissioner of the state Department of Transitional Assistance, said in a written statement. Under the new cash assistance reform the small percentage of clients who currently exceed the $2,500 asset limit will have their accounts immediately closed, and no balances will be allowed to go over the limit in the future, Monahan said. The change will affect those who are receiving benefits under the transitional aid to families with dependent children (TAFDC) program or emergency aid to the elderly, disabled, and children (EAEDC) plan. The department will also expunge cash benefit balances on accounts that have been inactive for 90 days, the commissioner said. -For more on High EBT balances see the full Boston Globe article… -EBT photo ID information adapted from Important Updates: Implementation of Housing and Homelessness Programs After Final Approval of the FY'14 Budget, e-mail from Kelly Turley, MA Coalition for the Homeless, July 25, 2013. Pooled Disability Trusts Protect Assets and Preserve MassHealth and SSI Eligibility Pooled disability trusts are vehicles for protecting and administering funds for individuals with disabilities, especially for those who do not have family members who can serve as competent, disinterested trustees and whose funds are insufficient to justify the expense of a professional trustee. The primary goal of these trusts is to preserve beneficiaries' eligibility for public benefit programs, such as Medicaid (MassHealth in Massachusetts) and Supplemental Security Income (SSI). Pooled disability trusts offer professional management of trust funds by non-profit organizations whose purpose is to serve individuals with special needs. There are two types of pooled disability trusts. The first is a so-called "third-party" trust holding funds contributed by someone other than the beneficiary, such as a parent or a grandparent. The other is a "self-settled" trust funded with assets that belong to the beneficiary with special needs. While the rules for MassHealth and SSI are complicated and beyond the scope of this article, the availability of assets and income can bar an individual from eligibility for MassHealth, which provides health coverage, and for SSI, which provides cash benefits. In addition, if an individual transfers money into trust for her own benefit, typically the trust funds would be considered available to the individual and continue to render her ineligible for benefits. Pooled disability trusts, whether self-settled or third-party, are exceptions to these rules. Upon the beneficiary’s death the trust typically retains 25% of the remaining funds (for administrative costs) before the rest is dispersed to reimburse MassHealth for outlays and/or distributed to other family members. The specific inheritance rules differ between self-settled and third-party trusts. Pooled Trusts in Massachusetts There are three principal pooled disability trusts in Massachusetts, the Berkshire County ARC Special Needs Trust, the CJP Disabilities Trust, and the MARC Trust. Following is information on each:
-Adapted from, and learn more at: http://www.margolis.com/articles/pooled-disability-trusts-their-time-is-now. Two of Boston’s landmark AIDS organizations are joining forces, announcing a “strategic partnership” Thursday between Fenway Health and the AIDS Action Committee of Massachusetts that leaders say will improve care as people are living longer with the virus, while bolstering the stability of services amid shrinking federal and state support. “Our infrastructure is at a breaking point,” said Rebecca Haag, AIDS Action’s president and chief executive. In the past 10 years, state funding for AIDS services has dropped by 38 percent, Haag said, “but the number of people living in Massachusetts with HIV has increased by 44 percent.” Under the partnership, approved by boards of both organizations, Fenway Health and AIDS Action will unite to become one corporate structure, but each will retain its nonprofit status, name, mission, and separate offices. Fenway’s board will assume financial responsibility for the new entity, while board members from AIDS Action will assume an advisory role. Haag will remain chief executive of AIDS Action, while Dr. Stephen Boswell, Fenway’s president and chief executive, will be in charge of the newly merged organization. Boswell said patients will probably not see any immediate changes, but will ultimately benefit because the new organization will be able to streamline services by combining forces. The organizations, for instance, will save money by sharing information technology services, administrative functions, and even cleaning services. AIDS Action — known for helping HIV patients find housing, transportation, and other community services — will tap its expertise to connect patients living on the fringes with medical care at Fenway, a prominent community health center that serves a wide array of Boston residents, leaders from both organizations said. -See the full Boston Globe article… The MBTA announced this month that it will partner with a local non-profit to provide improved travel training for seniors and people with disabilities who are considering using public transportation to reach their destination. In years past, the T has provided help showing people around the public transportation system and planning routes that would best accommodate their needs. With this new program, called Ways2Go and funded with a federal grant, the T will be able to hold more extensive travel training seminars and reach a larger number of commuters. The training program will be operated in partnership with Door2Door Transportation, a Somerville-based organization that provides disabled people with rides to medical appointments and necessary errands. The training is also a cost-saving measure for the transit authority. Last year, the T came under fire for doubling fares for users of The Ride, from $2 to $4, a move that many felt worsened quality of life for disabled riders whose tight budgets required them to cut back on outings. The program, if successful, could help commuters dependent on The Ride transition to using subway, commuter rail, or bus service — a trend that would save the T cash in the long-run. Cochran said the training would help disabled residents save money, too. -See the full Boston Globe article…
Software Helps the Blind See Via Smartphones – Coming Soon It can be hard to find what you’re looking for at the supermarket - even harder when you’re blind. But shopping recently got a lot easier for Karla Geagan, a legally blind 15-year-old from Wayne, Penn. She has been testing new technology from Visus Technology Inc., a Boston company that programs smartphones to identify people and objects. “I can point at anything, no matter how far away, and it’ll tell me what it is,” said Geagan, “In the grocery store, I just point it to the food item, and I know instantly what it is.” Geagan is one of nine middle-school students who have completed a two-week test of the Visus Visual Assist System, conducted by Carroll Center for the Blind in Newton and cosponsored by the cellphone carrier Verizon Wireless. The Visus software was installed on Samsung Corp.’s Galaxy S4 smartphones. “It allows a blind or visually impaired person to utilize the speech capability of an Android phone, with the camera capability, to do a variety of visually related tasks,” said Brian Charlson, the Carroll Center’s director of technology. The Visus system is set to go on sale early next year. Its $999 price tag will include a Galaxy S4 phone, a wireless Bluetooth earpiece, and a 4G wireless hot spot for sharing the phone’s 4G data service with other devices. Chief executive Stephen McCormack said the company hopes to offer a version for Apple Inc.’s iPhone by early 2015. The Visus software comes with a host of visual aids. Geagan’s favorite feature identifies retail items by scanning them with the phone’s camera. The software consults a database of common retail products to identify the goods. Another tester with limited eyesight, 15-year-old Kyle Quinnzaino of Everett, is a big fan of the phone’s magnification system, which uses the camera’s zoom lens to display enlarged images of hard-to-see items, like the Carroll Center’s cafeteria menu. Another Visus feature lets the user scan a large area with the camera to pinpoint objects containing text, such as signs or bulletin boards. The software can translate the text to speech and read it aloud. The phone also makes it easier for a blind person to find a restroom. It is programmed to recognize the standard symbols indicating a men’s room or women’s room and point them out to the user. The software can even generate a map of the inside of a building. Using software licensed from a defense contractor, Visus can shoot a video as the user is guided through the building. The next time the user visits the location, the software uses this video map to tell him how far to walk and when to turn left or right. -See the full Boston Globe article …
One Care- MA Pilot Program for Dual-Eligibles Cut Back Massachusetts health insurers’ reluctance to join a national experiment to improve care for disabled lower-income adults has forced the state to scale back the program even before it starts. Massachusetts is among the first states to roll out the national program, but half the insurers that were expected to participate backed out because they feared losing money. That will mean fewer options for patients when enrollment opens for the voluntary “One Care” program in October. (“One Care” is the name recently given to the Massachusetts dual-eligible- Medicare and MassHealth- demonstration program for those under 65, also known as Integrated Care Organizations or ICOs. For more information see Dual Eligibles Demonstration Project Timeline Revised, MGH Community News, March 2013) . Enrollees in most Massachusetts counties would have had four or more insurers to choose from under the original plan. Now, about half of eligible enrollees will have just one choice. Five counties — Bristol, Berkshire, Barnstable, Dukes, and Nantucket — will be excluded because no insurer signed on to serve customers there. Some patient advocates say a smaller, slower start may be better for vulnerable patients, allowing time to work out the inevitable kinks of any new initiative. Three health plans have signed on: Commonwealth Care Alliance, Fallon Total Care, and Network Health. The organizations will receive one payment to provide all mental health, medical, substance abuse, dental, and long-term support services. The goal is to encourage investment in preventive services and intensive case management to avoid expensive hospitalizations. Boston Medical Center HealthNet, Neighborhood Health Plan, and the state’s largest insurer, Blue Cross Blue Shield of Massachusetts, had won a bid to participate but said in recent weeks that they would opt out, citing inadequate pay rates and expected losses. Several patient groups have expressed concern that the program could result in cuts to personal care attendants or other nonmedical support services that allow people with severe needs to continue living on their own or in a community setting. The cost of those support services became one major roadblock for Blue Cross, said chief operating officer Bruce Bullen. The proposed pay rates did not explicitly factor in personal care attendants or dental services, he said. And, unlike others in the program, Blue Cross does not serve people on Medicaid today, so it was “more of a leap” for the insurer to create a system to serve the dually eligible, those on Medicaid and Medicare. Representatives of BMC HealthNet, whose revenue helps to support Boston Medical Center, and Neighborhood Health Plan, owned by Partners HealthCare, also said the risk of losing money on the program was too high. Acting state Medicaid director Kristin Thorn said she thinks the remaining insurers, all with Medicaid experience, are the right ones to launch the program. Commonwealth Care Alliance, which will serve the most counties, already contracts with the state to manage care for disabled seniors. Through its clinical network, it serves other adults, many of whom probably will enroll in the new payment system come fall. -See the full Boston Globe article … In 2014, major parts of the Affordable Care Act (ACA) will go into effect. The Kaiser Family Foundation recently released a cartoon to help explain the important changes to the way many Americans will get health coverage. The approximately 6-minute video gives a big-picture overview of major changes and encourages viewers to learn more. - From Medicare Watch, Volume 4, Issue 29, Medicare Rights Center, July 25, 2013. Affordable Care Act (ACA) Implementation Means Big Changes As reported previously (Major MA Healthcare Coverage Changes to come in 2014, MGH Community News, April 2013), implementation of the Affordable Care Act (ACA) will mean changes to the Massachusetts health coverage landscape starting at the beginning of 2014, and ramping-up this fall. Here are some additional details/changes from what was reported in April. Under the ACA, MassHealth will expand to cover adults with incomes up to 138 percent of the federal poverty level (FPL) in a new plan called MassHealth CarePlus. Some people currently enrolled in other MassHealth coverage types, such as MassHealth Essential, will move to this new plan, as will people at this income level who are currently enrolled in the Commonwealth Care program, and some people who are currently uninsured. People with incomes from 139 to 400 percent of FPL, including some current Commonwealth Care enrollees, and certain legal immigrants with incomes from 0 to 400 percent of FPL, will be eligible to enroll in Qualified Health Plans (QHPs) sold through the state's Health Insurance Connector and subsidized through federal tax credits. People receiving unemployment benefits who are currently enrolled in the Medical Security Program (MSP), which is being eliminated, will move to the CarePlus plan or to QHPs, depending on their income level. The state will receive enhanced federal revenue—75 percent, instead of the usual 50 percent of costs in FY 2014—for the new MassHealth enrollees, and will realize savings as some people transition from state programs to federally subsidized QHPs. A portion of these savings will be used to provide supplemental wrap coverage for people moving from Commonwealth Care to QHPs, in order to maintain their coverage at existing levels. -Adapted from and more information at Massbudget.org.
ACA Employer Mandate Delayed; Mass Version RepealedThe Obama administration recently announced a one-year delay on the federal employer mandate provision of the Affordable Care Act (ACA), which affects businesses with more than 50 employees and that would levy fines between $2,000 and $3,000. The state’s landmark 2006 health care law included a provision, referred to as the “fair share employer contribution,” requiring that employers with more than 10 workers provide coverage or pay the state $295 per employee. The repeal of this provision was included in the state’s FY 2014 budget as part of preparing for the 2014 implementation of the ACA. Governor Patrick has allowed the state repeal to stand even though the federal provision will be delayed. During a monthly segment on WGBH’s Boston Public Radio, Patrick pointed to a separate per-employee surcharge that businesses already pay to support the state’s Medical Security Program, covering people who are on unemployment insurance. That program will being eliminated in January, and most enrollees will be eligible for coverage through Medicaid or the state’s subsidized insurance market. But the surcharge will remain, at $50.40 per employee, and will be used to support subsidized coverage more broadly. Patrick said that the surcharge raises about five times as much money as the employer mandate did. “I think as long as the federal mandate isn’t delayed beyond that one year, we’ll be fine,” Patrick said. “Experience taught us that, here in the Commonwealth at least, employers aren’t deciding to offer health insurance to their employees on account of the mandate. It’s because the programs make sense and they work.” Consumer group Health Care for All had pushed for Patrick to veto the repeal and allow the state mandate to stand, citing concerns that the federal law could be delayed further. Executive Director Amy Whitcomb Slemmer on Thursday afternoon called the repeal “a significant step back from the promises that were made” in the 2006 law, which also mandated that most individuals in Massachusetts have insurance or pay a fine. She said the group will monitor coverage rates in the year ahead to see what impact, if any, the repeal may have. “We hope employers will continue to do the responsible thing and offer their employers coverage,” she said. -See the full Boston Globe article ... MassHealth Dental Fillings Benefit to be Restored In 2010 the state cut MassHealth restorative dental coverage for most adults. In last year’s budget, effective January 1, 2013, the legislature restored coverage of fillings for front teeth (likely in response to advocates’ argument that missing or decayed front teeth affects members’ employability). This year’s budget (for FY14, that began on July 1, 2013) earmarks $17.2 million to restore coverage of fillings for ALL teeth for this population. The change will likely go into effect on January 1, 2014 (Editor's Note: Effective date of new coverage has been postponed to 3/1/14.). MassHealth restorative dental services that are still not covered for this population include dentures, root canals, deep scaling, crowns, and surgical procedures related to dentures. Populations fully covered for dental services under MassHealth: Children, Adults with intellectual disabilities who are served by the Dept of Developmental Services and Seniors who are on Senior Care Options plans (SCO's). There are alternatives for dental care. Health Safety Net covers dental services at Community Health Centers that have dental clinics. Capacity at these clinics, however, is tight. See: Massachusetts Community Health Center Dental Program Directory or list of health centers that offer dental services. Some dental schools also offer discounted care at special clinics. -Adapted in part from Oral Health Advocacy Taskforce - Huge Budget Win!, e-mail from Courtney Chelo, Health Care for All – Massachusetts, July 08, 2013. Medicare- New Process for Some Durable Medical Equipment Requests (“Competitive Bidding”) The Medicare Competitive Bidding demonstration for Durable Medical Equipment (DME) expanded to 91 communities on July 1, 2013. Areas new to the program include Boston-Cambridge-Quincy, MA-NH, Providence-New Bedford-Fall River, RI-MA, Springfield, MA and Worcester, MA (see the full list). The aim of the competitive bidding demonstration is to allow the federal government to secure lower prices on medical equipment, which in turn would mean savings for Medicare beneficiaries and taxpayers. Examples of DME include walkers, wheelchairs, power scooters, diabetic testing supplies and oxygen tanks. Original Medicare beneficiaries may have received a notice from Medicare about the program. Under the DME Competitive Bidding Program, people with Original Medicare who live in certain areas must use a select group of contracted suppliers to get many types of DME. For the most up-to-date list of Medicare contract suppliers, visit Medicare.gov/supplier and enter the ZIP code. Select the product category of the item you need to view or print a list of Medicare-contract suppliers you can use. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. A customer service representative can help you find a supplier. Those currently renting durable medical equipment or oxygen and oxygen equipment, whose current supplier isn’t listed, may be able to continue renting the equipment from that supplier if the supplier decides to become a “grandfathered” supplier. The supplier will notify customers in writing if they’ll continue to rent the equipment. If the supplier decides not to become a grandfathered supplier, they’ll notify customers in writing to make arrangements to pick up the equipment. Note that the program does not affect all areas or all types of DME. Remember, the DME Competitive Bidding Program only affects those with Original Medicare. It does not affect those who have a Medicare Advantage plan, also known as a Medicare private health plan. Those with Medicare Advantage plans should contact their plan to see which suppliers are in the plan’s network of providers. For more information see Medicare’s Competitive Bidding website. Or as noted above, visit Medicare.gov/supplier and enter the ZIP code. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. -Adapted from and for more information: Dear Marci,Volume 12, Issue 15, July 29, 2013, Medicare Rights Center, DMEPOS Competitive Bidding Expands in Round Two, Medicare Watch, Volume 4, Issue 27, Medicare Rights Center, July 11, 2013 and http://www.medicare.gov/pubs/pdf/11663.pdf. Can Patients Protect Themselves From Hospital Medicare "Observation" Status? A number of Medicare beneficiaries are spending days in the hospital before being transferred to a nursing home, only to find that Medicare won't pay for their nursing home stay because they were considered to be under " observation " while in the hospital and not actually "admitted." Unfortunately, there isn't much you can do to prevent this from happening initially, but there are some steps you can take once you know it’s an issue. Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. In part due to pressure from Medicare to reduce costly inpatient stays, hospitals often do not admit patients but rather place them on observation to determine whether they should be admitted. Although according to Medicare guidelines it should take no more than 24 to 48 hours to make this determination, in reality hospitals can keep patients under observation for days. There are other consequences to being considered under observation. Instead of billing you under Medicare Part A, which covers inpatient services, the hospital will bill you under Medicare Part B. This means that you will owe a co-payment for every service offered. Your total co-payment could be much larger than the one-time deductible you have to pay under Part A. If you are in the hospital for any length of time, ask hospital personnel what your status is. Keep asking because it can be changed from day to day. If you are told you are in the hospital under observation status, you can ask the hospital doctor to be admitted as an inpatient. You should also contact your primary care physician to ask if he or she can call the hospital and explain the medical reasons that you need to be admitted. If you are kept in observation status and transferred to a nursing home and denied coverage by Medicare, you can appeal. To appeal, you must wait for your Medicare Summary Notice (MSN) to arrive. Copy the notice and highlight the disputed charges. The notice should provide information on where to send the notice to request an appeal. You can appeal both the hospital's denials of hospital admission as well as subsequent nursing home charges. The appeal process can be very complicated and you may need the help of an attorney to navigate it. More information about the Medicare appeals process. -See the full ElderLawAnswers.com article ... -Cited in/linked from News from Margolis & Bloom, LLP - July 30, 2013, Margolis & Bloom, LLP, July 30, 2013.
Sedative Use Drops at Nursing Homes A pilot program to reduce the use of antipsychotic drugs in 11 Massachusetts nursing homes lowered rates by 21 percent in the first year, according to data provided to the Globe by the state’s nursing home trade association. The initiative, organizers said, was prompted by a 2010 Globe analysis that found use of the powerful sedatives in Massachusetts nursing homes was the 12th highest in the country, with thousands of frail elders, many suffering from dementia, receiving the medications unnecessarily. Encouraged by the results, the industry group expanded the campaign to 104 other homes last year, but preliminary results from the first few months show reductions in those facilities were less dramatic, 7 percent. That was little different from the 6 percent drop seen in homes not participating in the program. Organizers say they will have a better sense of whether the larger program is working after a full year of data is in later this year. Using a $182,000 state and federal grant, Mass. Senior Care in September 2012 expanded its OASIS program, which trains nursing home staff to use alternatives to sedation for residents who are agitated and aggressive and who wander. OASIS teaches staffers that aggressive behavior by a resident who is no longer able to speak may be that person’s way of communicating pain, and to search for the source of the pain, for instance an untreated urinary tract infection. The program also teaches staffers to comb residents’ pasts to learn their preferences, hobbies, and accomplishments, tapping bedrock emotions that endure long after memory fades. That helps workers tailor activities and surroundings for each resident, to make the place familiar and comforting. Laurie Herndon, director of clinical quality for the Massachusetts Senior Care Foundation said the foundation aims to secure more grants to expand the program to additional nursing homes. -See the full Boston Globe article …
In what’s become an annual ritual, the Massachusetts Medical Society has just released its check-up on just how hard it is to get in to see a primary care doctor in this state. Bottom line: Mostly pretty hard, at least for a non-emergency first appointment. You’re likely to have to wait a month or two. At more than half of practices, you’ll be told, “Sorry, we’re not taking new patients.” One bright spot: If you have public insurance - Medicaid or Medicare - most Mass. doctors will still see you. From the press release: Massachusetts Medical Society President Ronald Dunlap, M.D. said “Our latest survey once again points out a critical characteristic of health care in the Commonwealth. While we’ve achieved success in securing insurance coverage for nearly all of our residents, coverage doesn’t guarantee access to care. The concern is that limited and delayed access can lead to undesirable results, as people will seek more costly care at emergency rooms, delay care too long, or not seek care at all.” Primary Care Trend Data Medical Society officials say the trend data for access to primary care shows cause for concern. While the numbers have fluctuated from year to year, the percentage of family physicians accepting new patients has dropped 19% over the last seven years; the percentage of internists accepting new patients has plunged 21% over the last nine years; and the percentage of pediatricians accepting new patients has fallen 10% over the last four years. Access to specialists continues to be much easier than it is for primary care, with 85% of cardiologists, 92% of gastroenterologists, 84% of OB/GYNs, and 98% of orthopedic surgeons accepting new patients. Medicare Despite some national reports that physicians are abandoning Medicare in other areas of the U.S., the overwhelming majority of physicians in the Commonwealth continue to participate in the Federal insurance program for seniors age 65 and older. MassHealth (Medicaid): Consistent with last year’s findings and in line with Medicare, primary care specialties are the least likely to accept MassHealth. However, physician participation in this program increased by 6% among family physicians and by 12% among internists in 2013. Pediatrics saw a decrease in acceptance, at 83% for 2013, down from 86% last year. -See the full summary article and links to the report at: http://commonhealth.wbur.org/2013/07/mass-primary-care-access. For-Profit Tenet Healthcare Returns to MA The pending return of health care giant Tenet Healthcare Corp. to Massachusetts has the potential to shake up the state’s hospitals and doctors networks, which are already rapidly consolidating. The for-profit system, which owns 49 hospitals in 11 states, will enter a marketplace much changed from the one it left in 2004, when the chain sold Saint Vincent Hospital in Worcester and the MetroWest Medical Center hospitals in Framingham and Natick to Vanguard Health Systems Inc. for $126.7 million. By agreeing recently to buy for-profit Vanguard — a deal that will bring the three Massachusetts hospitals back into the Tenet fold — Dallas-based Tenet signaled that it has become more aggressive about expanding nationally at a time when more patients will be signing up for medical insurance under the new national health care law. Vanguard is expected to close by the end of the year. The purchase also raises several questions that probably won’t be answered until it takes effect. Among them are what changes might be expected at the state’s three Vanguard-owned hospitals— Saint Vincent, Framingham Union Hospital, and Leonard Morse Hospital in Natick — and how the giant acquisition will affect Vanguard’s alliance with Tufts Medical Center in Boston, which has a clinical affiliation with the MetroWest hospitals and has jointly pursued the acquisition of Massachusetts community hospitals — thus far unsuccessfully — with Vanguard. Because it had bid for several community hospitals, there was widespread expectation Vanguard might expand — and perhaps even buy the state’s other for-profit hospital chain, Steward Health Care System of Boston. Under one scenario, Vanguard would combine its three hospitals with Steward’s 11 and refer patients to Tufts for complex care. Now that speculation will shift from Vanguard to Tenet. -See the full Boston Globe article … To Reduce Turnover NH Creates Videos About Reality of Human Services WorkIn 2010, New Hampshire Department of Health and Human Services officials created videos that candidly explain the work of three different types of jobs within the social work field. The jobs can be stressful, and turnover has been high. The department is now seeing less turnover among employees in their first 12 months on the job, and officials think the videos are helping. Job seekers are required to watch the videos before submitting applications. The videos already available online feature the work of child protective services workers, adult protective services workers and family services specialists; staff will create videos about the work of youth counselors and mental health workers this summer. Among social workers in charge of determining who is eligible for services, 35 percent who left their jobs were in their first year. Two years after the department began using the videos as part of the application process, that number fell to 24 percent, said Lori Weaver, a department administrator. Turnover of child protective services workers in the first 12 months has dropped from 15 percent to 10 percent, Weaver said. Training each new worker for some of the positions can cost as much as $40,000 each, said Maggie Bishop, director of the Division of Children, Youth and Families. Counseling young people is “a very challenging job where you never know what’s going to happen next. It’s a high-stress job, and I’ve seen through the years people not really understanding what it means,” she said. “This job is not real until you’re out there knocking on someone’s door, or at the Sununu Center and a child is becoming volatile, but I’ve heard from others who have seen the videos and decided it’s not for them. So showing them some of the reality of the job was good.” It’s not all doom and gloom; workers in the videos talk about how it feels when they make a difference for clients, from a child placed in a safe home to an elderly man thanking his protective services worker for being his only visitor in the last weeks of his life. “The business we do, it’s very important to the public,” Weaver said. “We want to make sure the people we hire are going to stay. They’re working with families and communities, and it can be very disruptive to have a caseworker come in and then after six months they leave.” View the videos at: http://www.dhhs.state.nh.us/media/av/realisticjobpreview_intro.htm -Read the full Concord Monitor article ... -Thanks to Sally Hooper for forwarding.
Will Fixing Up Seniors’ Homes Help Them Age in Place? Environment can be as disabling as disease, and too often, older Americans wind up in a nursing home not because they are so ill but because at home they can’t get through their days safely. A major research project will bring handymen, occupational therapists, and nurses to the homes of 800 low-income seniors in Baltimore to test if some inexpensive fix-ups and strategies for daily living can keep them independent longer, while saving millions in taxpayer dollars spent on nursing home care. -See the full Boston Globe article … Developers Creating Games to Treat Mental Health Issues Late at night, in the middle of a panic attack, 25-year-old Zoe Quinn used to get out of bed to play video games. By the light of her computer screen, she immersed herself in another universe, and her anxiety slipped away. Now, the Dorchester woman wants to make gaming for others what it was for her: a therapeutic, purposeful way out of dark times. Her passion makes her part of a growing movement among gamers and doctors alike to use the medium to educate the public and diagnose, and even treat depression or anxiety. Quinn has created a simple, free, Web game called “DepressionQuest.” Players click through the deeply realistic narrative of a first-person character, making choices for the character about work, friends, and family. The game shows options for dealing with depression, such as seeking therapy or medication, or reaching out to friends. “DepressionQuest” isn’t clinically tested. (Though she got advice from a therapist, she warns that suicidal people should not play.) But Quinn wanted sufferers of depression to know they’re not alone — and show those who haven’t experienced depression what it’s like. Game developers hope that one day they might supplement therapy and support groups by putting mental health care into patients’ homes or pockets. The demand for therapists far outstrips the supply nationally, and many who most need help with mental health issues can’t afford or reach treatment, or don’t seek it out. Developers are largely focused on making games that engage our ability to be mindful, aware, alert. People with depression, anxiety, attention deficit disorder, traumatic brain injury, and some elderly people have weaker brain functioning in these areas. Games can test those abilities — and, researchers hope, train the brain to improve at such tasks. But most of the games have yet to go through rigorous testing to see whether they work — or might inadvertently harm patients. While drugs must be approved by the federal government and states license many therapists, games are unregulated. The US Food and Drug Administration plans to require approval for only a “small subset” of Web or mobile medical apps “that may present potential harm to consumers,” a spokeswoman for the federal agency said in an e-mail. She said some video games purporting to treat or diagnose mental health conditions could be subject to agency review. -See the full Boston Globe article …(including more examples of games under development and current research projects). FDA Approves New Treatment for Opioid Dependence The US Food and Drug Administration (FDA) has approved Zubsolv (buprenorphine/naloxone, Orexo AB) for maintenance treatment of opioid dependence. Zubsolv is a once-daily, sublingual tablet with a formulation of buprenorphine and naloxone that fully dissolves within minutes. According to a release issued by Orexo AB, the drug's manufacturer, Zubsolv has higher bioavailability, faster dissolve time, and smaller tablet size, with a new menthol taste that previous research has shown is highly acceptable to patients. "Zubsolv has, in previous studies, showed a high acceptability compared to the leading treatment modalities in the market.” Nikolaj Sorensen, president and CEO of Orexo AB, said in a press release. The company announced that the drug will be launched in September in the United States by its subsidiary Orexo US in partnership with Publicis Touchpoint Solutions. -See the full article FDA Approves New Treatment for Opioid Dependence, Medscape. Jul 05, 2013. Veterans Find Public Service Therapeutic By helping returning troops regain their sense of purpose, veterans’ groups are proving that public service is therapeutic. The Mission Continues, which is based in St. Louis but has fellows serving throughout the country, is at the heart of a growing community-service activism among this generation of combat veterans. Groups are sprouting spontaneously across the country, building houses, working in health care, teaching, counseling, farming and taking care of their more seriously wounded comrades. Team Rubicon, based in Los Angeles, has a roster of about 7,000 veterans ready to do disaster-relief missions around the world; it was co-founded by a Mission Continues fellow, Jake Wood. There are other groups that help veterans reintegrate through physical exercise like running or cycling. In some cases, these organizations have started to partner with one another — Team Rubicon has joined with Team Red, White & Blue, which organizes long-distance runs for veterans; Mission Continues fellows are serving with Team Rubicon for post-tornado disaster relief in Oklahoma. By the end of 2013, more than 800 veterans, most of them wounded, some severely, will have passed through the Mission Continues fellowship program. An initial study of 52 TMC fellows, conducted by Dr. Monica Matthieu and three Washington University colleagues, showed dramatic improvement in well-being after a six-month fellowship: 86% of the fellows reported a positive life-changing experience, 71% went on to further their education, and 86% said the program helped them transfer their military skills to civilian employment. This is especially impressive, given that 52% of those studied had suffered traumatic brain injuries and 64% had been diagnosed with posttraumatic stress. “These are positive results,” Dr. Matthieu says, “but we just don’t have enough data yet to say with any certainty how often public service succeeds as a therapy for PTSD.” Although the data about the beneficial effects of community service on recent veterans is skimpy, there is a wealth of more general evidence that shows the physical and psychological benefits of service, particularly for the elderly. Dr. Nancy Morrow-Howell of Washington University has conducted many of the relevant studies — for the White House Conference on Aging, for AARP — which show that community service provides clear health and psychological benefits, including greater longevity, reduced depression and a greater sense of purpose. “Actually, the elderly are a really good comparison group for wounded veterans,” says Dr. Morrow-Howell, a co-author of the Mission Continues study. “They have to cope with a reduced ability to function physically. Many of them lose their sense of purpose and community after retirement. If they’re widowed, they feel isolated. They need to rebuild their lives, rejoin the world.” In a remarkable study from Ohio State University, two groups of elderly patients in senior day care were asked to make gift baskets. One group made them for themselves; a second group was told they were making the baskets for homeless people in their community. The second group experienced a greater sense of satisfaction and psychological well-being than those who were simply making the baskets for themselves. “Service enables them to find their value outside their own suffering,” says Barbara Van Dahlen, the founder of Give an Hour, a group of mental-health counselors who work with veterans, headquartered in Bethesda, Md., but serving across the country. “I don’t think there’s a mental-health professional on the planet who would disagree with the basic principle that serving others is therapeutic. This is not rocket science.” -See the full Time Magazine article ... |