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MGH Community News |
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MGH Community News |
| December 2014 | Volume 18 • Issue 12 |
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. |
US Orders Mass to Address Food Stamp Photo ID Confusion Massachusetts last year became one of the first states to require food stamp cards to include photos of recipients, but the new program has created such confusion that some low-income families are unable to buy groceries and the federal government is demanding that the state quickly fix the problem. The Electronic Benefit Transfer or EBT cards, act like debit cards and are issued to heads of households. But some store cashiers have turned away the recipients’ family members or others in the household - who can legally use the benefits - because they do not match the photos. Such practices violate federal rules, which require retailers to treat food stamp recipients like any other customer. The PIN is the key security feature and is like an electronic signature. If the proper PIN is used, the shopper should be able to use the card. It is unclear how widespread the problems were. But they were significant enough that the US Department of Agriculture, which oversees the food stamp program, recently sent state officials a strongly worded letter detailing concerns about the implementation of the photo cards. The USDA dispatched agents to Massachusetts in August and found that state workers were inadequately trained about rules governing the photo cards, and subsequently, so were recipients and retailers. The USDA also found that elderly and disabled residents were denied benefits unless they had their pictures taken, even though the state specifically exempted them from photo requirements. In addition, the USDA said, many families had benefits cut off for up to three weeks because their old cards were deactivated before they received new cards in the mail. “There are significant concerns with regard to client access to program benefits,” the USDA said in the Dec. 2 letter, threatening to withdraw administrative funding for the program unless the problems are resolved. The federal government, which funds food stamps, pays half the costs that states incur to administer the program. Stacey Monahan, commissioner of the state Department of Transitional Assistance, disputed the USDA’s findings, saying that the federal agency provided little evidence in the letter to back up its assertions. Her staff met with the state’s largest retail trade group, for example, asking it to spread the word about handling the new cards, Monahan said. She is preparing a detailed response to the USDA. The Legislature enacted the photo requirements in August 2013 under pressure to address public perceptions of fraud in the food stamp and other benefits programs. |
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Patricia Baker, a senior policy analyst at the Mass Law Reform Institute (MLRI), an advocacy group that opposed the photo requirement, said the amount of fraud in public assistance programs is relatively small and photo requirements ultimately punish struggling families who use the cards legitimately. The USDA’s review of the Massachusetts program confirms that, she said. Baker said the institute has fielded many phone calls from supermarket staff and managers trying to understand the photo requirement.
MLRI is conducting an outreach campaign to educate EBT users about their rights. Key messages include that those under age 19 or over age 60, people with disabilities, domestic violence survivors and those with a religious objection having a photo ID are exempt from the photo requirement and can contact their DTA worker to get a non-photo ID. In addition to reiterating the message that stores cannot refuse to let household members (such as spouses or children) use an EBT card just because another household member’s photo is on the card, MLRI also notes that stores must treat EBT card users the same as other customers. For example, a cashier cannot ask to see the EBT card unless all other customers paying by debit/credit card are also asked for a photo ID. MLRI has also created informational flyers In English, and In Spanish. Those who feel they have been discriminated against because they tried to pay with an EBT card, or were told they cannot use a household’s photo EBT card, are encouraged to call MLRI at 617-350-5480 x222. -See the full Boston Globe article... -Additional material from MIRA BULLETIN Tuesday, December 9, 2014. New Proposed Assisted Living Rules Proving Controversial Assisted Living Facilities could not accept residents, or allow them to remain in the facility, if the residents require more than 90 consecutive days of skilled nursing care, under rules proposed by the Massachusetts Executive Office of Elder Affairs, which is charged with overseeing assisted living residences. (See Proposed Rules Would Offer New Assisted Living Protections, MGH Community News, November 2014.) Regulators detailed their proposals this month at a meeting of the Assisted Living Advisory Council, an appointed board of industry leaders and consumer representatives. Industry leaders are warning that the proposed rules may end up limiting elders choices. “We see that as a conflict of residents’ rights. Residents have a right not to be evicted,” said Elissa Sherman, president of LeadingAge, which represents about 30 nonprofit assisted living residences. If a facility evicts residents, the proposals would require administrators to provide residents, and their legal representatives, with a notice justifying the decision, including an explanation of why the facility can no longer meet the needs of such residents. Industry leaders also expressed concerns about a provision in the proposed regulations that would allow state officials to change rules without the usual public hearing process. “We cannot have a system in which government can subvert an established public process and dictate regulatory changes without review and debate,” Michael Banville, acting president of the Massachusetts Assisted Living Facilities Association, said in a statement. “We strongly urge [regulators] to remove the . . . language.” A spokeswoman for the Office of Elder Affairs said in a statement that the new provision is “not intended as a substitute for regulations or to establish new requirements,” but did not address the industry concerns about circumventing public input. The new rules are expected to go into effect in January, but industry leaders said they will urge the agency to delay some provisions that call for additional training because it can take several months to bring staff members up to speed.The updated guidelines mandate education in two areas of special concern: recognizing and reporting elder abuse, and improving techniques for managing and calming aggressive behavior, something commonly encountered in caring for patients with dementia. State regulators worked on the updates for close to a year and a half, and finally released a draft last month. -See the full Boston Globe article... New State Guideline Suggests DCF Filing for All Unexplained Infant Deaths State social workers should be routinely alerted to investigate all unexplained infant deaths in Massachusetts for signs of abuse and neglect, according to new state guidelines scheduled to go to police, firefighters, and hospital workers by the end of the year. While the advice cannot be legally mandated without a law change, the guidelines will create a baseline for emergency personnel when considering whether to report a death to social workers, said Carlene Pavlos, a state Department of Public Health official. The recommendations are meant to improve investigations of deaths attributed to Sudden Unexpected Infant Death, the leading cause of mortality among children between the ages of 1 month and 1 year in Massachusetts. They will also apply to other unexplained child deaths. While police often alert the Department of Children and Families to unexplained deaths, the new guidelines are intended to assure that all infant deaths are reported to the agency. Emergency workers will be advised to notify DCF social workers whenever they encounter the unexplained death of a baby, according Pavlos. The recommendations are part of a 55-page report recently released by the state Child Fatality Review Team, a group cochaired by the public health department and the Office of the Chief Medical Examiner. According to the report: “The recommendation, which will be distributed to mandated reporters statewide, states that any unexplained death of a child establishes reasonable suspicion of abuse or neglect and advises reporting these deaths” to DCF. The fatality review team was created by the Legislature in 2000 to examine deaths of children and recommend ways to prevent future tragedies. Each year, dozens of Massachusetts children die suddenly and unexpectedly. In 2009 and 2010 combined, 90 infants under the age of 1 died, according to the report. Risk factors involve what are known as unsafe sleep conditions — such as putting children to sleep on their belly, sleeping with an adult, or with excessive bedding. Black non-Hispanic infants were three times as likely to die as white non-Hispanic babies between 2001 and 2010, the report says. But the new guidelines already are prompting concern from some families and groups involved in the prevention of unexpected infant deaths, which include sudden infant death syndrome, or SIDS, as well as accidental suffocation and entrapment, and other unexplained causes. Among them is Milford Police Chief Tom O’Loughlin, who lost his 3½-month-old son, Michael, to SIDS on the Monday before Thanksgiving in 1992. He said the new directive could cause unnecessary pain for families suffering from the death of a child. “If there are no facts and circumstances that indicate neglect or abuse, I don’t believe that the family should be subjected to a DCF investigation,’’ O’Loughlin said. DCF spokeswoman Cayenne Isaksen said that when it comes to sudden infant deaths, the agency is most focused on educating families and caretakers about reducing risks, referring interested parties to visit www.mass.gov/SafeSleep to learn more. Other key recommendations on infant deaths that come from state and local teams urge:
-See the full Boston Globe article...
An independent monitoring group will open an office inside troubled Bridgewater State Hospital for the next two years to make sure that prison guards and clinicians continue reducing their use of isolation and physical restraints on mentally ill patients, under a deal with the state that averts a lawsuit. “The agreement guarantees that over the next couple of years, someone will be in there watching, looking at the data, talking to the patients and staff, and really trying to make sure that people are treated appropriately as patients and not as prisoners,” Christine M. Griffin, the executive director of the federally funded Disability Law Center, which reached the agreement with the Patrick administration, said. The center had threatened to sue Massachusetts for what it said were widespread human rights abuses at Bridgewater, where the Globe has identified three deaths in recent years related to the use of restraints to control patients. Under the agreement the center will not sue as long as the state follows through on a host of promises of better care, including a plan to move most of the patients to a proposed facility at an undetermined location to be run by the Department of Mental Health. The agreement stops short of meeting one of the Disability Law Center’s central demands: transferring control of the facility from the Department of Correction to the Department of Mental Health. The group released a scathing report in July charging that prison officials are not qualified to run the mental health facility. However, Governor Patrick has filed a sweeping legislative proposal that includes the establishment of a new, secure facility under the management of the Department of Mental Health for Bridgewater patients who may be violent but are not serving criminal sentences. That represents about 80 percent of the patients being treated at Bridgewater today. And Griffin said her organization will continue to pursue the goal of transferring control of Bridgewater State Hospital itself when Governor-elect Charles Baker takes office in January. Under the agreement with the Disability Law Center, the administration has pledged to discontinue the use of five-point restraints altogether and to revise its official policy on the use of seclusion and restraints by mid-January. Meanwhile, Bridgewater State Hospital officials have replaced existing restraint beds with larger, more comfortable beds, and cut the overall use of restraints by 86 percent and the use of seclusion by 68 percent, since January, according to the Department of Correction. Other features of the new agreement include:
Still, the Patrick administration has said Bridgewater officials will continue to face significant challenges that can be met only with financial assistance from the Legislature. Bridgewater faces a shortage of mental health clinicians compared with facilities run by the Department of Mental Health. At Bridgewater, each psychiatrist is responsible for twice as many patients as psychiatrists at Department of Mental Health facilities, according to the Department of Correction. In addition, staff members at Bridgewater have faced an increase in the number of assaults by patients as they have relied less on seclusion and restraint to control them. -See the full Boston Globe article... Accessing a Loved One’s Digital Estate Can be a Difficult Task About 2.5 million Americans die every year, and most leave behind a digital estate: financial records, old e-mails, photos, and videos. And hardly any of us prepare our next of kin for dealing with this stuff. It is an oversight that has can cause an extra measure of grief. It is a good reason to store all your passwords in a digital vault, then share the key with your next of kin. For $12 a year LastPass Premium provides password access through any desktop computer, smartphone, or tablet. You just need to remember a single master password for the LastPass account, and then share it with your next of kin. For a more comprehensive approach, there are online services that help you create an inventory of your entire estate, from insurance policies to Facebook pages. Sites such as AfterSteps, Principled Heart and EverPlans semi-automate the process. There are electronic forms for typing in vital data such as your social networks, online retailers, credit card and bank account data, and tools for building a will and giving instructions about medical care and funeral arrangements. You can choose a friend or family member to carry out your last requests. These services generally cost between $45 and $75 per year, though EverPlans offers a basic free service. And there is a new service to help people whose relatives didn’t put their electronic affairs in order. WebCease is a Portland, Ore., company that finds a deceased person’s online accounts and helps the survivors shut them down. Founder Glenn Williamson, previously with Boston Internet security company Rapid7, came up with the concept when his mother died. He found 13 online accounts he never knew she had, including a forgotten credit card and 54,000 frequent-flyer miles. Now his company charges $99 and up to track the digital footprints of the dead. “We find accounts that you don’t know about,” said Williamson, “and we tell you what your end-of-life options are.” There’s no simple push-button solution, because companies have different post-mortem policies, and the next of kin must deal with each of them. But at least they’ll know where to start. -See the full Hiawatha Bray Boston Globe column... Audit Finds $35 Million in Questionable MassHealth Limited Payments MassHealth paid out $35 million in reimbursements for health care, mostly for illegal immigrants, that were questionable or were not allowed to be paid for by MassHealth under federal regulations, according to state Auditor Suzanne Bump. MassHealth costs are split between the federal government and the state. Bump said the problematic expenditures place "an inappropriate burden on taxpayers." And, she said, "We have to get it in line before the federal government tells us we have been wrongly spending money." Under federal and state laws, Massachusetts provides MassHealth coverage for emergency services for low-income illegal immigrants and some immigrants who are here legally, such people whom the government has given temporary status. Of 45,000 people in the MassHealth Limited program during the audit period 89 percent were illegal immigrants. Bump's audit found that between July 2011 and December 2012, MassHealth approved $35 million in claims that doctors had not designated as emergency services. Of that, $27.8 million was for inpatient and outpatient services, and the rest was for prescription drugs and medical supplies ($3.6 million), dental services ($1.7 million) and rehabilitation and physical therapy ($1.9 million). The improper payments accounted for 45 percent of the total spending of the MassHealth Limited program. MassHealth, however, disputes the findings. At the core of the dispute is the question of what defines an emergency service. When a doctor submits a claim for payment, she must indicate whether the service was for an emergency. Bump's audit found that MassHealth routinely paid for services even when the doctor had not marked it as an emergency. Some of these claims were marked as "urgent" but many were for elective procedures or care for chronic diseases. "We're questioning their substitution of their own judgment for what the medical provider says," Bump said. Low-income immigrants not eligible for Medicaid can receive care from community-based free-care clinics or through the state's Health Safety Net program, where care provided by hospitals and community health clinics is funded primarily by hospitals and insurers, with some money from the state and federal governments. Brian Rosman, research director for the health care advocacy group Health Care For All, said even if changes proposed by the audit are implemented, no immigrant will be denied care. The money to pay for the care will just come from a different place. "The audit makes no allegation anyone got inappropriate care," Rosman said. "What the audit uncovered is accounting issues where some medical care was charged to the wrong pocket." -See the full MassLive article... Administration Designates Three West African Countries for TPS Effective November 21 the Department of Homeland Security designated Guinea, Liberia, and Sierra Leone for Temporary Protected Status (TPS) due to the Ebola outbreak that has ravaged the region. TPS for these 3 countries will be effective for 18 months (through May 21, 2016) and will provide recipients with employment authorization. In order to be eligible, an individual must have continuously resided in the United States since November 20 and cannot have left the country since then. They also cannot have any serious criminal issues. To apply, applicants must submit Form I-821 and I-765 by May 20, 2015. Fee waivers will also be accepted for those individuals who can show that they (1) receive any means tested benefits (2) are at or below 150% of the Federal Poverty Guidelines or (3) suffer from a financial hardship. To apply for a fee waiver, applicants must submit Form I-912 with the rest of the application package. For more information on registering for TPS, including the types of evidence to submit, application costs, and where to file, please visit www.uscis.gov/tps. -From Sí se puede, podrá, pudo: MIRA BULLETIN, December 9, 2014.
Obama’s Immigration Expansion Does Not Include Access to Federal Health and Most Economic Support Programs On November 20, 2014, President Obama announced a series of actions on immigration. These actions include the creation of the Deferred Action for Parental Accountability (DAPA) program and an expansion of the existing Deferred Action for Childhood Arrivals (DACA) program (Obama’s Executive Action on Immigration, MGH Community News, November 2014). DACA and DAPA recipients will be considered lawfully present in the U.S. during the period of their deferred action grant. They will be eligible for work authorization, but they will not be eligible for most federal health and economic support programs. If otherwise eligible, they will be able to access the Earned Income Tax Credit, Child Tax Credits and possibly, at some time in the future, Social Security and Medicare. They will NOT be eligible for the following:
Social Security and Medicare – Possible Future Eligibility Once DACA and DAPA recipients receive work permits, they may apply for a Social Security number (SSN) and can begin to accumulate social security work credits towards Social Security Disability insured status, Social Security Retirement and Medicare. But keep in mind that these programs are set to expire in 3 years. The program would need to be extended long enough for them to acquire the necessary number of work credits before they would be eligible. IF the program is extended beyond the current 3 year term. Tax Credits – Eligible if Otherwise Qualify The Earned Income Tax Credit (EITC) is a tax credit for working people with low or moderate income. Because DACA and DAPA recipients are eligible for SSNs, they will be treated the same as any other taxpayer who files federal income taxes with an SSN. DACA and DAPA recipients may claim EITC eligibility for themselves and their children who have SSNs if they are otherwise eligible. Advocates encourage those eligible to apply for the EITC noting that the EITC lifts more low-income families out of poverty than any other benefit program. The Child Tax Credit/Additional Child Tax Credit (CTC/ACTC) is a tax credit for low-wage working families to help them pay for their children’s most basic needs. Families are eligible whether they file their taxes with an SSN or an Individual Taxpayer Identification Number (ITIN). An ITIN is a tax processing number issued by the IRS regardless of immigration status. Therefore, DACA and DAPA status does not provide any change in eligibility for the CTC/ACTC. In fact, these individuals may become ineligible for this credit if their income goes up. -Adapted from and for More Information: See the National Immigration Law Center’s Fact Sheet: DACA and DAPA Access to Federal Health and Economic Support Programs. New Plan to House Boston Homeless Displaced by Long Island Evacuation The city has settled on a squat brick building across the street from Boston Fire Department headquarters in the Newmarket area to house many of the homeless people displaced from the shelter on Long Island, Mayor Martin J. Walsh recently announced. Walsh said he expects about 100 homeless people to be able to move into the space in mid-January. He said the building will be able to house as many as 490 people by April. The building at 112 Southampton St., which is owned by the city, lacks showers and sufficient bathrooms and may require a host of other renovations to prepare it for the more than 450 people who relied on the refuge in Boston Harbor. The Long Island Shelter was closed in October after the city abruptly condemned the rickety bridge that connects it with the mainland. Originally, Walsh had vowed to have the homeless moved to modular buildings off Frontage Road this winter. That plan was scrapped in early December amid complaints by neighbors. The mayor said the new shelter could permanently replace the Long Island shelter. He said the city will demolish the old bridge soon and start designing a replacement. But he has not made a decision whether to rebuild it.
“Long Island could be repurposed for other things,” he said in a City Hall interview.
The latest shelter plan was welcomed Monday by the city’s homeless advocates, many of whom have raised concerns in recent weeks about how long it has taken the city to find a suitable property that could be opened this winter. “This is the best solution I’ve heard of all the solutions proposed,” said Karen LaFrazia, executive director of the St. Francis House, a day shelter where 25 women from Long Island are sleeping on cots in the atrium and dining room. “I think the idea that they’ll be able to bring on the additional capacity as fast as they can is really important.” LaFrazia noted that the Newmarket building is a few blocks from the city’s intake center for the homeless at the Woods-Mullen Shelter, as well as from the Boston Healthcare for the Homeless Program, Boston Medical Center, and an array of other public services, including transportation. Lyndia Downie, president of the Pine Street Inn, which has been supplying food to the temporary shelters where many homeless have lived since Long Island closed, called the mayor’s announcement “good news.” “I know this building needs some work; that can’t happen quickly enough,” she said. “I’m very happy and grateful that they found what looks like a permanent site, even if it’s a temporary permanent site.” Walsh said the city has begun consulting neighbors of the building in Newmarket, which include the Suffolk Bay House of Correction, Best Western’s Roundhouse Suites, and a McDonald’s. Walsh said he does not expect as much backlash as there would have been in other neighborhoods, given that the building is in an industrial area with no nearby residential buildings. The 45,000-square-foot building is now used by the sign shop of the Boston Transportation Department. Walsh said its 48 employees will be moved early next month to a building on Channel Street in South Boston. The mayor said he does not know how much it will cost to refurbish the building, but he said the city would spend the money needed to turn it into a shelter. Walsh said he has spoken to contractors who have offered to help the city do the work quickly and charge the city only for materials, not for labor. City officials said they are evaluating whether they can add a kitchen. But the city still has to work out some of the details, including obtaining all of the permits and zoning to convert the building into a shelter. Walsh said the city is still looking for a home for many of the addiction recovery programs that were shuttered when the island closed on Oct. 8. He said officials are searching for the right property to house more than 200 people. Walsh said the building on Southampton Street will need new fencing, an array of new plumbing, and a design that will allow men and women to live there, as they did at the shelter on Long Island. He said the city would be convening a new homeless task force with the hope of designing a shelter that will not just house the homeless but also help them find permanent housing. The closing of Long Island, Walsh said, could end up being a “blessing.” “This could be a better solution,” he said. -See the full Boston Globe article... American Psychiatric Association Ups Efforts to Raise Awareness of Mental Health Parity Law The American Psychiatric Association (APA) has launched a new tool to help raise awareness that mental health parity is the law and that mental health insurance coverage must be on par with health insurance for physical illness. The association has distributed a poster entitled Fair Insurance Coverage: It's the Law to psychiatrists and other mental health providers in the hope that they will post it in their offices and waiting areas and share it with colleagues. "This is a simple, nonintrusive way to get information about the law to patients and tell them how they can take steps to make sure they are being treated fairly," Paul Summergrad, MD, APA president and psychiatrist-in-chief, Tufts Medical Center, Boston, Massachusetts, told Medscape Medical News. The parity poster reminds patients that the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibits insurers from discriminating against people who have a mental illness, including a substance use disorder, and that coverage for a mental health issue must be on par with that of a physical health problem, such as heart disease, diabetes, and cancer. But many patients may not know what constitutes a violation of their rights under the law. Written for a lay audience, the poster explains a patient's rights under the law and what steps to take when they suspect a violation. There is a place on the poster for healthcare providers to add their state insurance commissioner's contact information. Specifically, the poster tells patients the following:
-See the full Medscape article... -Learn More and download poster -The American PSYCHOLOGICAL Association also has a patient guide on the same theme: Does Your Insurance Cover Mental Health Service?
Pet Loss Resources Heartache over a deceased pet is becoming more openly expressed and more socially acceptable. Those who work closely with grieving pet owners say they also see a change in public expression. Here are some pet loss-related resources adapted from a recent Boston Globe article:
-See the full Boston Globe article... Boston Marathon Bombing Trial Approaching- Survivor Support Services Update Currently the trial of the Boston Marathon bombing suspect is scheduled to begin in mid-January. The trial and its attendant media coverage is likely to lead many survivors to feel the need for increased support. The new Massachusetts Resiliency Center (www.MAresiliencycenter.org) at Boston Medical Center (BMC), which opened this past summer, was established to offer free support to anyone who was impacted by the bombings. This includes the families of those killed, individuals who were physically injured and their family members, individuals in the area of the bombing or events that followed in Cambridge and Watertown, who may have suffered trauma from witnessing or experience the events, professional and non-professional first responders, and others who by virtue of their unique history may have been triggered or traumatized by these events. The center was funded by federal grant money administered by the U.S. Department of Justice’s Office for Victims of Crime and operations and is overseen by the Massachusetts Office for Victim Assistance (MOVA). Upcoming Resiliency Center events and programs include a quilt-making workshop, a Resiliency and Wellness support group, and a Trial Support and Information session that will provide general information about what to expect regarding the trial, including how to deal with the media, logistical information at the courthouse, coping and emotional support during the trial, and personal experience of a trial from a victim's perspective. All MOVA sponsored services for these survivors can be accessed through the Resiliency Center at (844) STRONG-1 or by visiting MOVA’s website at www.mass.gov/mova. Other Resources There are also services for those with physical injuries from the attacks and their families getting underway from the One Fund Center at Mass. General Hospital and Mass. Eye and Ear Infirmary in conjunction with the Benson Henry Institute. For more information please contact Barbara Thorp, LICSW, Program Director for the One Fund Center at MGH and MEEI, at 617-391-5995 or bthorp@mgh.harvard.edu. -Thanks to Andra Sobran and SuMing Solberg for forwarding these resources, and Barbara Thorp for her assistance with this article. Federal Student Aid Total and Permanent Disability Discharge (Loan Forgiveness)
People with total and permanent disabilities may qualify for federal student loan forgiveness, called a total and permanent disability (TPD) discharge. This applies to the William D. Ford Federal Direct Loan (Direct Loan) Program loan, Federal Family Education Loan (FFEL) Program loan, and/or Federal Perkins Loan (Perkins Loan) Program loan or completing a TEACH Grant service obligation. The U.S. Department of Education then makes an eligibility determination. One can show total and permanent disability in one of the following three ways:
Up to 120 Day Suspension Period Once one notifies Neinet that they want to apply (by contacting them at the number or e-mail below, or by starting an online application), Neinet will contact the loan holders and instruct them to suspend collection activity on those loans for a period of up to 120 days. The suspension of collection activity is intended to give applicants time to complete the TPD discharge application and return it for processing. If Neinet does not receive the completed application within the 120-day period, the loan holders will resume collection activity. To Apply Apply online, call Nelnet at 888-303-7818 – open seven days a week from 8:00 a.m. to 8:00 p.m. (Eastern) or email them at DisabilityInformation@Nelnet.net. Adapted from, More Information and the Application see: disabilitydischarge.com/Application-Process/ Also see FAQs. -Thanks to Jennifer Kubic for informing us of this important program. Addendum: In spring 2016 the Obama administration announced the Department of Education will begin working with the Social Security Administration to identify individuals who receive disability benefits and have a designation of permanently disabled (“medical improvement not expected”) and who have outstanding student loans. Those individuals will receive a letter explaining how they can get their student loans discharged without having to provide additional documentation proving they meet the “totally and permanently disabled” standard. Before pursuing a discharge, individuals should understand the tax and health insurance consequences for themselves and others in their household, since the amount of the student loan forgiven may be treated as income for tax purposes. (More information see: Department of Education to Forgive Student Loan Debt for Thousands of People with Disabilities, MGH Community News, May 2016.) Services Offer A Means To Foil Widespread 'Elder Fraud' This is the season for generosity — and for con artists who take advantage of it. Older adults are particularly vulnerable to scams. But now there are products on the market designed to protect seniors' nest eggs. Kai Stinchcombe’s grandmother probably gave away tens of thousands of dollars to questionable charitable causes. So Stinchcombe started a company called True Link. It issues prepaid Visa debit cards to older adults. True Link, working with families, can customize each card to block specific kinds of payments, such as wire transfers or sweepstakes entries or casinos. "We're able to configure the card in such a way that it will decline payment for the type of transactions that are problematic," Stinchcombe says. Older people who are victimized once tend to be victimized over and over again, says Doug Shadel, a fraud expert with AARP. "Once you participate in one of these things, even if you only send in $3, you're really signaling to the con artists that you're someone who participates in this, compared to the majority of people who do not," Shadel says. For Howard Tischler's mother, the problem began when she purchased an auto club policy from a telemarketer that cost $80 a month. Tischler says his mother was legally blind, didn't own a car and didn't have a driver's license. One useless purchase led to many others and, eventually, to credit card bills of around $20,000. Tischler, a software developer, thought it would be great if families could be tipped off to these problem purchases immediately, before the bills get out of hand. So he founded Eversafe. The company scans all of the bank accounts, credit cards and investments of an older adult on a daily basis. If something looks fishy, the older adult — and his or her designated family members — are notified. Tischler says this enables older adults to continue to live independently, but to have "an extra set of eyes." The AARP has a Fraud Watch Network where hundreds of thousands of members report new scams when they see them. Anyone can also sign up for their Watchdog Alerts. -See the full NPR story...
Medicare Reminder: One-Time Transition Drug Refills Every year, Medicare drug plans may change which drugs they cover and the rules and restrictions associated with obtaining coverage for those drugs. Now that Medicare Open Enrollment has closed, come January some Medicare members will have new coverage or formularies under their existing coverage. Some may find that a drug they have been taking is no longer covered. A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that Medicare drug plans must cover when one is in a new plan or when an existing plan changes its coverage. Transition fills offer temporary coverage for drugs that one has been taking that aren’t on the new plan’s formulary or that have restrictions on them. One can only get transition fills for drugs one was already taking before switching plans or before the existing plan changed its coverage.All Medicare Part D drug plans must cover transition fills. The rules apply to both Medicare Advantage plans that include drug coverage and Medicare stand-alone drug plans. When one uses a transition fill, the plan must send a written notice within three business days. The notice will state that the supply was temporary and that the member should either change to a covered drug or file a request with the Part D plan (called an exception request) to ask for coverage. Learn more on Medicare Interactive. -Adapted from Medicare Watch, The Medicare Rights Center, December 04, 2014. Medicare Pilots Pre-Authorization for Non-Emergency Use Of Ambulances In PA, NJ and SC Seniors living in three states will now need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments. The change is part of a three-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies in Pennsylvania, New Jersey and South Carolina. The good news is that Medicare beneficiaries in those states will now know beforehand whether the program will cover their non-emergency transportation to treatments. The bad news, say advocates, is that many fragile people will be left with no way to get to appointments that might mean the difference between life and death. If cost savings are shown, the program is expected to be expanded nationally. Kate Kraemer, billing manager at Direct Bill Inc., which helps a Pennsylvania ambulance firm collect Medicare payments, said the demonstration will keep dialysis patients from being surprised by bills that are denied weeks after they receive the service. Those bills can range from $150 to $600 per roundtrip for three visits a week. But Kraemer said the project doesn’t do anything about the real problem - patients who don’t qualify for reimbursed transportation, but who do not have friends or family to drive them and are too weak after a three-to-four hour dialysis session to drive themselves. Many cannot afford the cost of any form of transportation. Since Medicare doesn’t cover non-medical transportation at all, some patients gamble that it will cover use of an ambulance - even when less expensive transportation might be more appropriate. For a patient to qualify for transportation to and from treatment under Medicare, they have to require the medical attention an ambulance provides - for instance, be confined to bed or need medical care like intravenous fluids during the trip. Most Medicare Advantage plans offer transportation to get to doctor appointments and treatments, but at most, those plans cover only 20 trips a year. Scott Bogren, communications director of the Community Transportation Association of America, made up of public and private transportation and health entities, said the group will push for a transportation benefit in Medicare as awareness spreads about the costs of chronically ill patients missing critical appointments. “Our concern for years has been that a lot of trips that aren’t ideally provided in an ambulance are going in an ambulance because there’s no other way to do it,” Bogren said. “If something requires constant, routine transportation, the concern is that if you’re not Medicaid eligible, how do you make that work?” -From Medicare Tightens Non-Emergency Use Of Ambulances To Combat Fraud, by Lisa Gillespie, Kaiser Health News, December 1, 2014. This article was produced by Kaiser Health News (KHN) is a nonprofit national health policy news service, with support from The SCAN Foundation. -See also: the CMS website.
Mass. Health Connector Extends Payment Deadline The Massachusetts Health Connector extended until Sunday (December 28) the deadline to pay for coverage that starts Jan. 1, after thousands of consumers inundated the agency’s call center in a quest to meet the original Tuesday deadline to buy health insurance. The extension applies only to those who selected a plan by midnight Tuesday. Maydad Cohen, the top official overseeing the website, said the goal of the extension that was announced midday Tuesday was to “alleviate the pressure consumers are feeling,” and also to free up customer service representatives to focus on plan selection rather than payment. The Connector’s call center had received 2,580 calls by noontime. Frustrated consumers seeking help by phone waited on hold for close to an hour throughout the day. The wait time for an agent to pick up was 55 minutes at noon; the average for the day was 41 minutes. But the website, built to replace one that failed last year, managed unprecedented spikes in traffic without slowdowns, Cohen said. Some consumers, however, have found the payment system frustrating. To make an online payment, customers have to go to a separate website. But if they log out of the Connector website, they lose access to identification numbers needed to process the bill. In addition, once a payment is made, the website does not provide confirmation that it has been received. People can pay by mail, but payments must be postmarked by Sunday. Roger Block, 62, of Newburyport, said he signed up for health insurance for himself and his wife Dec. 3 but never received an invoice. “I’ve been calling every two or three days,” he said in a phone interview. “People are not well-trained. The communication skills are really weak. . . . There appears to be no documentation system. Every time, you’ve got to go through whole story again,” he said. Eventually, someone gave Block an account number, and he paid the bill. “I made a payment online, without an invoice,” he said. “It’s really, really poor service . . . and it’s scary.” However, Block’s insurer verified his enrollment, he said. Although Tuesday was an important milestone, the Connector’s work is far from over. Open enrollment continues until Feb. 15. People who miss the December deadlines can buy insurance effective Feb. 1, and people who wait till Feb. 15 to buy a plan can get coverage effective March 1. The Health Connector’s call center will be open from 9 a.m. to 3 p.m. Sunday to assist those taking advantage of the payment deadline extension. Because of the time required to process payments, people may not receive their insurance cards until a few days after Jan. 1, but their coverage will be effective on that date. -See the full Boston Globe article... Tips from The Connector and MassHealth Preferred Web Browsers The Health Connector recommends using Chrome 30, Firefox 30, or Internet Explorer 10 or later. Those using older web browsers will find that some functions may not work as they are supposed to and can result in strange behaviors when browsing the site or completing an application. (This tip added 1/12/15.) Tips for Online Payments When making an online payment, we recommend keeping your application and account open on one tab of your browser, and the payment system open in another tab, so you can go back-and-forth between your application and payment page as necessary to fill in the information requested to make an online payment. At the very least, before you leave the application portion of the website, you should write down your Enrollment ID number (starts with RefID) which you can find in the My Enrollments screen, and your premium amount from your application. You will need to enter this information into the payment system. Further instructions about online payments, with screenshots, is available through the Getting Started Guide at https://www.mahealthconnector.org/making-online-premium-payments-for-your-2015-health-or-dental-plan Some consumers have expressed concern that their online payment has not been processed because they did not receive a confirmation email. If a consumer made an online payment and did not receive an email that the payment could not be processed, then the payment likely went through with no errors and the consumer can expect their account to be debited within 2-3 business days. Also note if a consumer has made an electronic payment or paper payment for Jan. 1, 2015 coverage - and the information provided is correct and matches the information entered in your application - the consumer will be enrolled regardless of whether they have received a confirmation notice or not. Due to the volume of payments, confirmation notices are taking longer than expected to be mailed. This will not impact the ability to get covered for Jan. 1, 2015. Follow these steps to ensure that your online payment is entered correctly:
Tips for Payments by Mail Consumers who would like to pay their premium by mailing a check or money order should not wait for their bill in the mail given the limited window to pay by Sunday, December 28 for January 1, 2015 coverage. Consumers do not need a billing account number in order to submit their payment. How to Make a Payment by Mail
Patrick Announces New Funds to Reduce Chronic Homelessness Governor Deval Patrick launched a new effort this month to reduce the state’s chronically homeless population funded by $3.5 million from private investors, the state’s second “pay for success” program. The goal of the program is to stabilize the lives of up to 800 longtime homeless individuals - nearly half the state’s chronically homeless population - by providing them with permanent housing while at the same time reducing the amount of taxpayer money that would otherwise have been spent on shelter, Medicaid, and other emergency services for these individuals. The state will only repay the money, plus a modest return - up to $6 million in total - if the project is deemed a success by an independent evaluator. In this case, success means housing individuals for at least a year. If only half the tenants stay for a year or more, the investors will suffer a loss. If 85 percent stay the year, investors get a 3.33 percent return. If all the tenants make it a year or more, investors will get the maximum return of 5.33 percent. The project will be led by the newly formed Massachusetts Alliance for Supportive Housing, a collective that will work with providers to secure 500 units of housing, as well as job training and medical care for tenants. The program will start early next year with 50 units of housing, and gradually scale up to 500 over two years. The state has dedicated rental vouchers to help maintain many of the 500 housing units for the chronically homeless beyond the six-year initiative. In 2012, Massachusetts became the first state to announce that it would use this social financing system, also known as social impact bonds, which was pioneered in the United Kingdom. In January, the state launched a $27 million juvenile justice initiative funded by the investment firm Goldman Sachs and other foundations to help the Chelsea nonprofit Roca to reduce the rate at which young offenders return to jail. The first evaluation will be held in two years. -See the full Boston Globe article... The Huge Health Care Gap Between Whites and Minorities is Starting to Narrow In 2002, a landmark Institute of Medicine report awoke the world to shocking inequality in the health-care system. The report's conclusion: racial and ethnic minorities tend to receive lower quality of care than whites do, even after accounting for factors like income and insurance status. The reasons for the disparity were complex and varied. The IOM pointed to differences in how minorities sought out health-care services, uncertainty among doctors on diagnosing and treating patients from different racial or ethnic backgrounds, and how health systems were financed and designed, among other reasons. So how does this translate to the real world? It means if you're a white patient entering a hospital, you're more likely to get certain treatments than black and Hispanic patients are. For example, about a decade ago, 43.4 percent of white patients coming into the heart attack received an angioplasty within 90 minutes of entering the hospital, compared to just 29.2 percent for black patients and 34.1 percent for Hispanic patients. That's one of the pretty stark findings from a recent New England Journal of Medicine study, which actually uncovers encouraging evidence that hospitals are reducing racial disparities in care. Reviewing more than 12 million hospitalizations between 2005 and 2010, researchers set out to find whether hospital quality was improving — and whether minority groups were still being left behind. By 2010, angioplasty rates for all heart attack victims rose dramatically as the disparity gap also narrowed, according to the study. That year, 91.7 percent of white patients received the procedure within 90 minutes, compared to 86.3 percent of blacks and 89.7 of Hispanic patients — so the treatment gap between whites and blacks was cut by more than half in those five years. The researchers found additional progress as well. Looking across 17 quality measures for heart attacks, heart failures and pneumonia, researchers found that racial disparities were reduced in every category between 2005 and 2010. Importantly, they found hospitals were providing care more equally within hospitals, as well as between hospitals — meaning hospitals that serve higher rates of minority patients also saw improvements, the study authors wrote. Meanwhile, another new analysis from the Urban Institute shows how the Affordable Care Act's coverage expansion is narrowing the health insurance gap. The think tank projects that the Hispanic uninsured rate, the highest among any ethnic group, will drop from 31 percent to 19 percent by 2016, and the uninsured rate for blacks will drop from 20 percent to 11 percent. The coverage gains for minority groups would be even greater if every state expanded their Medicaid programs. As of Jan. 1, 27 states and Washington, D.C., will have accepted the ACA's Medicaid expansion, while three more governors are asking their legislatures to approve the program in 2015. -See the full Washington Post article... Automatic Income Tax Rate Cuts and Impact on State Services The Governor recently announced the need to cut funding for school transportation, job training, health care, and other investments. One of the reasons for these cuts was the anticipated triggering of an automatic tax cut caused by a twelve year old law. "While our Commonwealth could be making investments to expand opportunity for all of our children and improve lives in our communities, this automatic tax cut will primarily benefit the wealthy and it will likely force cuts in education, transportation, and other investments in our people and our economy," said Noah Berger, President of MassBudget. This tax cut, which primarily benefits the highest income taxpayers, will cost the Commonwealth $145 million a year. It is part of a series of automatic income tax rate cuts that together will cost the Commonwealth $325 million this fiscal year. The annual cost could grow to over $800 million over the next five years. This could significantly weaken the Commonwealth's ability to rebuild our crumbling infrastructure, invest in expanding access to high quality education, and protect access to affordable health care. MassBudget's new fact sheet Automatic Income Tax Rate Cuts: FAQ describes how this automatic tax cut works and examines its likely consequences. This tax cuts has its origins in a series of income tax cuts that began in 1998. Those tax cuts cost the Commonwealth over $3 billion a year and, in the years since, we have seen deep cuts in education, local aid, and other important public services. Boston Homeless Numbers Worst of Major Cities Boston had the largest number of homeless in emergency shelters in the past year — surpassing much larger cities such as Los Angeles and Chicago — in a survey of about two dozen major cities released this by the U.S. Conference of Mayors. The report detailed overflow conditions in Boston’s shelters, where the numbers are expected to rise this year. “I can’t say I’m surprised,” said Lyndia Downie of the Pine Street Inn shelter. “We’re a very, very expensive housing market and a lot of smaller towns in the state don’t have homeless shelters, so they end up coming to Boston. We end up really serving a statewide function.” Boston, with a 2012 estimated population of 636,479, reported 16,540 people in emergency shelters over the past year, while Los Angeles, with an estimated population for that same year of 3,857,799, counted more than 14,000. The survey included Washington, D.C., Dallas and Phoenix, but not the largest U.S. city — New York City. Boston shelters were forced to turn away homeless people over the past year, according to the report, which predicts a rise in homeless families this year. State funding for shelters has increased by about $7.5 million since 2001, but advocates argue it isn’t enough. Mayor Martin J. Walsh’s office said the report “demonstrates that we need every level of government, philanthropy and the private sector working together with us to prevent and end homelessness.” -See the full Boston Herald article... -Population statistics from U.S. Census- July 2012 estimate Doctor for Poor Chosen as MA Public Health Commissioner A physician who has spent much of her life ministering to the most impoverished residents in Massachusetts will soon take the reins at the state’s Department of Public Health. Dr. Monica Bharel, chief medical officer at the Boston Health Care for the Homeless Program, was tapped Tuesday by the administration of Governor-elect Charlie Baker as the next state health commissioner. The appointment elated health advocates, who said the 44-year-old Bharel has demonstrated an unwavering commitment to improving the lives of the state’s homeless and most vulnerable, stretching back two decades to her days in medical school. Bharel, who is on the faculty at Harvard Medical School and Boston University School of Medicine, will lead of one of the state’s most troubled agencies. The health department has been mired in controversy since 2012, when a drug analyst with the agency tampered with evidence and jeopardized tens of thousands of criminal convictions. That was quickly followed by a meningitis outbreak traced to a compounding pharmacy regulated by one of the department’s boards, and then the agency found itself in the cross hairs again because of the problem-plagued rollout of the state’s medical marijuana law. With more than 3,000 employees and a $540 million budget, the department regulates hospitals, nursing homes, and myriad other facilities, in addition to running more than 100 programs addressing everything from infectious diseases to substance abuse. Lyndia Downie, president of Pine Street Inn, one of the region’s largest homeless shelters, said Bharel is extraordinarily analytical and data driven — a “systems thinker,” but with a very human touch.When she treats homeless patients, she is “nonjudgmental, engaging, and easy to work with,” Downie said. Bharel also understands that the path to better health leads through affordable housing and good nutrition, Downie added. “Sometimes, the housing people and the service people don’t necessarily have the same goal in mind, and they don’t connect seamlessly,” Downie said. “So we have to create patchworks, and if there is anyone who understands the coordination, that systems have to work together, it’s Monica.” Bharel received her masters in public health through the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. Her medical degree is from Boston University. -See the full Boston Globe article...
Drug-Dependent Patients Attending Alcoholics Anonymous Rather Than Narcotics Anonymous Do as Well Abstract Aims Alcoholics Anonymous (AA) is the most prevalent 12-step mutual-help organization (MHO), yet debate has persisted clinically regarding whether patients whose primary substance is not alcohol should be referred to AA. Narcotics Anonymous (NA) was created as a more specific fit to enhance recovery from drug addiction; however, compared with AA, NA meetings are not as ubiquitous. Little is known about the effects of a mismatch between individuals' primary substance and MHOs, and whether any incongruence might result in a lower likelihood of continuation and benefit. More research would inform clinical recommendations. Method Young adults (N = 279, M age 20.4, SD 1.6, 27% female; 95% White) in a treatment effectiveness study completed assessments at intake, and 3, 6, and 12 months post-treatment. A matching variable was created for 'primary drug' patients (i.e. those reporting cannabis, opiates or stimulants as primary substance; n = 198/279), reflecting the proportion of total 12-step meetings attended that were AA. Hierarchical linear models (HLMs) tested this variable's effects on future 12-step participation and percent days abstinent (PDA). Results The majority of meetings attended by both alcohol and drug patients was AA. Drug patients attending proportionately more AA than NA meetings (i.e. mismatched) were no different than those who were better matched to NA with respect to future 12-step participation or PDA. Conclusion Drug patients may be at no greater risk of discontinuation or diminished recovery benefit from participation in AA relative to NA. Findings may boost clinical confidence in making AA referrals for drug patients when NA is less available. -See the full Medscape summary article... Biological Psychiatric Problems Garner Less Empathy Given more information about the biology of a mental disorder, doctors and therapists react with less empathy for the patient, a new study finds. The findings challenge the notion that biological explanations of mental illness boost compassion for millions of Americans who suffer from psychological conditions researchers reported December 1 online in the Proceedings of the National Academy of Sciences. "Our study demonstrates an example of the downside of the trend toward increasingly biological conceptualizations of mental health," lead author Matthew Lebowitz told Reuters Health. "Overemphasizing this idea that people with mental disorders have something fundamentally wrong with their brains can be dehumanizing," he said. Lebowitz, a psychology graduate student at Yale University in New Haven, Connecticut, and his colleagues asked 343 U.S. clinicians to read fictional stories about mental health patients paired with explanations based wholly or partly on either genetics and neurobiology, or on childhood experiences and stressful life circumstances. All clinicians reacted with less empathy to biological explanations and with more empathy to psychological explanations of symptoms. But medical doctors reported significantly less empathy overall than other clinicians, the study found. The authors could not explain why. "One of the benefits often touted for the biological explanations of mental disorders is that they can reduce blame and personal responsibility for their symptoms," Lebowitz said. "But there are some problems with that. Biological explanations can start to dehumanize patients." The authors note that the vignettes they presented were oversimplified and failed to capture the complexity of the etiology of mental disorders. The study cannot say whether clinicians facing patients with real problems would react the same way. If true, however, they caution that the findings may lead clinicians away from proven psychotherapy treatments. The study found biological explanations were tied to clinicians believing less in psychotherapy and more in medication. James Tabery, a professor at the University of Utah School of Medicine in Salt Lake City, said he found the study findings "worrisome." But he told Reuters Health he hoped the research would be used as a training tool to teach aspiring clinicians about the complex interplay between genetics, biology and environment in the development of psychiatric conditions. "The study does raise a troubling implication - the thought that the patient-physician relationship is compromised by these biological explanations. I would hope we could use this information to educate aspiring clinicians so that they don't (fall) victim to that trend, to bring it to their attention so they can actively combat it," he said. -See the full Medscape summary article...
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