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MGH Community News |
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MGH Community News |
| February 2014 | Volume 18 • Issue 2 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Victim Compensation Doubles Award Limit for Catastrophic Injuries Previous Awardees May Request Additional Funds Massachusetts’ Victim Compensation program has recently announced a doubling of the award limit for those who’ve experienced catastrophic injuries. Those who have experienced catastrophic injuries may now receive up to $50,000 rather than the $25,000 limit that applies to other injuries and losses. Previous awardees are eligible to apply for additional funds. These are maximum limits, not guaranteed awards. Individual award levels will be determined based on the amount of unreimbursed expenses, lost wages, etc., under program guidelines. The definition of catastrophic injuries:
The Victim Compensation Office is not able to review all previous claims, so it is important to get the word out to previous awardees who meet the definition that they may be eligible for additional funds. -Thanks to Amanda Breen for sharing this information and her help with this article. |
After two years of stalled negotiations, President Obama signed a new Farm Bill this month. The bill reauthorizes hundreds of programs for agriculture, dairy production, conservation, nutrition, and international food aid. Among the changes in the bill are cuts to the Supplemental Nutrition Assistance Program, formerly known as food stamps. Spending on the food stamp program will be reduced by $8.7 billion over the next decade. The reduction in spending will affect about 1.7 million people, who will have their benefits reduced by about $90 a month, according to the budget office. The bill’s proponents said the measure closed a loophole exploited by 16 states that helped food stamp recipients get more in benefits than they should have. These cuts will be on top of recent benefit reductions due to the end of the American Recovery and Reinvestment Act of 2009 supplement (SNAP Benefits Will Be Reduced for All Participants in November 2013, MGH Community News, September 2013). Additionally, SNAP is due for a second “hunger cliff” in the next couple of years, when a $6 billion automatic cut kicks in. Lawmakers say the deal will prevent the 16 states (including Massachusetts) from doling out more generous food stamps to people who get federal help to heat or cool their homes, even if the help is as little as $1; the so called “Heat and Eat” program. Here’s how “Heat and Eat” works: In most states people who spend more than half their income on housing and utilities are eligible for deductions which increase their benefit levels. For the most part, that means food stamp recipients need to show state agencies their housing and utility bills in order to claim the deduction. But in “Heat and Eat” states, anyone who qualifies for energy assistance is assumed to also qualify for the shelter deduction. That means that state agencies can automatically increase how much their citizens receive in food stamps by giving them a purely symbolic energy subsidy. Anyone who receives even $1 in energy assistance is eligible for more food stamp benefits than they would otherwise receive. Under new rules only people who receive a minimum of $20 in energy assistance will qualify for the deduction. The 16 so-called “heat and eat” states are California, Connecticut, Delaware, District of Columbia, Maine, Massachusetts, Michigan, Montana, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, Wisconsin. A 17th state, New Hampshire, does not distribute nominal LIHEAP payments but does allow an application for LIHEAP to qualify the household for the Standard Utility Allowance (which can result in a higher SNAP benefit). The Washington Post editorial board recently said that eliminating Heat & Eat would mean closing a massive “loophole” in nutrition law which provides some food stamp recipients with unearned benefit hikes. “While technically legal and undoubtedly well-intended, this maneuver results in many people receiving money based on utility expenses they did not actually incur,” wrote the Post’s editorial board. Caryn Long, director of the food bank coalition Feeding Pennsylvania, emphasized that “Heat and Eat” policies benefited those who already qualified for both food stamps and energy assistance.“They may be receiving a minimal benefit not because they’re not eligible for more, but because federal funding for the LIHEAP [energy assistance] program has been significantly cut,” she said. As msnbc reported earlier this week, federal energy assistance has been cut by one-third over the past three years. Lawmakers stress the move won't cut families from food stamps, it will just shrink the amount some families get. But antihunger advocates said the cuts would increase the number of people in need of food. While the bill adds about $205 million to food banks, Sheena Wright, the president of the United Way of New York City said “These cuts will be absolutely devastating... Two hundred million can in no way plug a nearly $9 billion hole.” Sources and for More Information:
SNAP Medical Expense Deductions Increase 3/1/14 One small ray of good SNAP news is that the medical expense deduction will increase on March 1, 2014. This deduction reduces one’s countable income and therefore increases one’s benefit level. Those who are at least 60 years old or are “certified” disabled (adults or children who receive SSI or SSDI) may deduct unreimbursed medical expenses and health-related expenses from their income. Under rules in effect until March 1, 2014, when an applicant shows proof of medical expenses of at least $36/month, DTA will automatically allow a standard $90 deduction from income. This standard deduction amount will increase to $155 as of March 1. So someone with as little as $36/month in expenses will be able to deduct the full $155 amount from their income to calculate the benefit level. After March 1, in situations where expenses exceed $190/month ($35 + the $155 deduction) DTA will deduct the actual value of these expenses from income, after the first $35. There is no cap on claim amounts. According to Mass Law Reform Institute’s (MLRI) SNAP Advocacy Guide, DTA workers are supposed to ask about applicant’s medical expenses and help them get verifications, but workers are overburdened with hundreds of cases and may not get to this. MLRI encourages applicants to tell DTA about all health and medical-related expenses of any household member who is elder or disabled, including over-the-counter medications, travel to doctors and pharmacies, service animal care, dental or vision care. Applicants should also keep their receipts as claims must be verified. For more detail and advocacy tips see SNAP Advocacy Guide: question 53- What medical expenses can I claim if I am elderly (60+) or disabled? 2014 Federal Poverty Guidelines Effective March 1 New federal poverty guidelines/levels become effective on March 1. See charts (and pdf and Excel versions) at: http://www.masslegalservices.org/content/federal-poverty-guidelines-2014. Federal poverty guidelines are used in determining eligibility for some means-tested programs such as SNAP and Emergency Assistance/Family shelter. They are also used for eligibility determinations for health care coverage programs such as ConnectorCare*, federal subsidies*, Health Safety Net and MassHealth. For the subsidized health care programs, please keep in mind that eligibility determinations for those under age 65 may use the MAGI methodology. Since MAGI should decrease countable income for most, those who may appear over-income from the charts may actually be eligible. *Correction: ConnectorCare and QHPs with tax credits will use the 2013 Federal Poverty Guideline/Level until the next Open Enrollment period (through November 14, 2014). See p. 2 of MassHealth & Other Health Programs Upper Income Levels chart.
Regulators Define Rules for SNF Care of Dementia Patients Workers in nursing home dementia care units will have to receive eight hours of initial training and four additional hours annually, under final rules state regulators recently adopted. The regulations, approved nearly two years after Massachusetts lawmakers passed legislation mandating minimum standards for these specialized units, also require that the facilities have at least one “therapeutic activities director” dedicated to the dementia unit to ensure meaningful and appropriate activities for residents. The rules close a loophole that had allowed nursing homes to advertise dementia units without any specific training for their workers, specialized activities for residents, or safety measures in place, such as high fences, to prevent residents from wandering. Few changes were made in the dementia care standards since they were unveiled last August by the Massachusetts Department of Public Health. They were finalized this month by the Public Health Council, an appointed body of academics and health advocates that sets public policy. The rules also require licensed nursing homes, and not just those with special dementia units, to provide dementia-specific training for all direct-care workers within 180 days. Regulators said it was important to mandate the training because roughly 60 percent of nursing home residents have some form of dementia. -See the full Boston Globe article...
Patrick Announces Reforms to Reduce Recidivism Setting a goal of reducing recidivism by 50 percent in the next five years, Gov. Deval Patrick recently unveiled a package of reforms aimed at shifting the criminal justice system’s focus to rehabilitation. Patrick, speaking at UMass Boston, announced initiatives to promote successful re-entry and to take a new treatment-oriented approach toward drug abuse and mental illness. Patrick said the effort to successfully prepare inmates to re-enter society must begin the moment they enter prison by providing more educational and training programs. He also pointed to "step-down" programs designed to let some inmates complete their sentences at county-based houses of corrections to better prepare them for life in the community and avoid troubles that could send them back to prison. The governor said another focus of the recidivism initiative is to treat substance abuse more like a health problem than a criminal issue. He called for greater access to substance abuse treatment programs for prisoners. He pointed to a new substance abuse recovery program using naltrexone, a medication designed to help individuals recover from opioid or alcohol dependence. The program is designed to continue after an inmate is released with follow-up injections and counseling. He said other steps aimed at tackling substance abuse problems include expanding detox and clinical stabilization services, adding 64 detox inpatient beds and creating a central intake to match individuals to treatment facilities. Patrick said physical restraints and solitary confinement shouldn’t be used on mentally ill inmates in any but the most extreme cases. He said he's also setting aside additional $1 million for training programs to help law enforcement officials learn how to de-escalate and properly handle people with mental health issues. His fiscal year 2015 budget also proposes doubling the number of mental health specialty courts that can help divert individuals away from incarceration and into treatment programs. The goal of limiting the use of restraints on mentally ill inmates follows the death of Joshua Messier, a 23-year-old diagnosed paranoid schizophrenic, after a scuffle with guards at Bridgewater State Hospital in 2009. Patrick is also calling for a renewal of the state's Sentencing Commission to ensure that sentencing laws are up to date in Massachusetts. In calling for a ban on the shackling of pregnant prisoners while in labor, Patrick noted that Department of Correction policy already prohibits the practice. He said the DOC will issue emergency regulations designed to extend the prohibition to all facilities. While the Department of Correction controls state prisons, each county jail has its own policies regarding pregnant inmates. Activists have been pushing a bill that would create uniform laws for the jails and the state prison system that would prohibit the shackling of pregnant women during childbirth and post-delivery recuperation. The bill would also set standards for the treatment and medical care of pregnant inmates, including nutrition, prenatal care and services for high-risk pregnancies. Eighteen states already ban the shackling of pregnant, incarcerated women. Additionally, Patrick issued a call to move beyond the “tough on crime” slogan of the past and embrace an approach based in “evidence, experience and wisdom....We think there is a more pragmatic, more effective and most efficient way to think about criminal justice, one that deals with the realities of today, learns from the experience of the past, and actually makes the public safer,” he said. Sources and for More Information:
Ellie Fund- New Application and Expanded Benefits The Ellie Fund’s patient support program, Care for the Caregiver, provides transportation to medical appointments, childcare, housekeeping, groceries and prepared meals free of charge for hundreds of women living through breast cancer treatment, and their families. The Ellie Fund has updated their application. The new application may be found at: www.elliefund.org/application. The password is Ellie (case sensitive) - for professional use only. Old forms will not be accepted beginning in March. Additionally, they will now reimburse patients for parking. Patients must submit parking receipts to the attention of Gail Fine, Director of Patient Services within the 2 month grant period. Any receipts received after the date noted on the patient grant letter will not be reimbursed. They are also expanding their “Dish and Deliver Prepared Meals” to include those who live beyond the local delivery area of an hour's drive from Boston. They are now able to ship small meals to patients who live alone or with one other household member. These meals will serve up to two people. Volunteers will continue to deliver meals directly to a patient's home if she lives within their delivery area. Consumer Alert- Electric Competitive Supplier Complaints Since the passage of Massachusett's electric utility Restructuring Act in 1997, electric customers are free to choose a "competitive supplier" for their electricity. Customers of National Grid, NSTAR Electric, Western Mass. Electric and Unitil/Fitchburg still have to pay those companies for distribution or delivery services (delivering the electricity to the customer's house, over the company's poles and wires), but the customer can purchase the actual electricity from a large number of licensed "competitive suppliers." Charles Harak, of the National Consumer Law Center (NCLC) recently reported that they’ve heard a number of troubling complaints against one of these suppliers Just Energy and some of the other suppliers. NCLC spoke to the Department of Public Utilities and learned that the Consumer Division encourages customers to file a complaint if they've experienced any problems with a competitive supplier. Complaints can be made by phone or in writing. The phone number and complaint form can be found here: https://www.mass.gov/how-to/file-a-complaint-involving-a-gas-electric-or-water-company -Adapted from e-mail correspondence from Charles Harak, NCLC attorney, to the utility network, utilitynetwork@lists.nclc.org, February 19, 12014.
Commonwealth Woodstove Change-Out Program The Massachusetts Clean Energy Center (MassCEC), with support from the Massachusetts Department of Environmental Protection and the Department of Energy Resources, launched a third round of the Woodstove Change-Out Program on Feb. 18, 2014. The program offers financial incentives to assist Massachusetts residents in replacing non-EPA-certified woodstoves with cleaner, more efficient wood or pellet stoves. Applications for this round will be accepted through March 4, 2014. Existing non-EPA certified wood-fired stoves must be replaced with new, low emission, high efficiency wood- or pellet-fired stoves. Stoves removed through this Program must be rendered permanently inoperable. Qualifying residents of any income may be eligible for vouchers of $750 off the cost of replacing their existing stoves. Certain low-income applicants may be eligible for vouchers of up to $2,000. To qualify for the low-income voucher, one will be asked to submit proof of participation in one of the following programs
All applications submitted through March 4 will be given equal opportunity to receive a voucher. If a high volume of applications is received, MassCEC will implement a randomized application selection process. For More Information or to Apply: www.masscec.com/woodstove
Commonwealth Care and Temporary Coverage Further Extended On February 13th, the Health Connector announced new steps in the Commonwealth's effort to preserve coverage for people with health insurance through the Health Connector. People covered by the Commonwealth Care extension program or who were previously Medical Security Plan members will have access to their coverage through at least June 30, 2014. Previously the Commonwealth Care extension ran until March 31. Additionally, the temporary coverage program, which currently covers more than 30,000 Massachusetts residents, will also be extended. Temporary Coverage MassHealth and the Health Connector are pleased to confirm that the Commonwealth will provide temporary coverage effective February 1, 2014 to applicants who submitted their applications for subsidized coverage in January. This temporary coverage will be available to those applicants who do not have other coverage through the Commonwealth and who haven't received an eligibility determination yet. Temporary coverage for January applicants will be processed in a phased approach but will have a retroactive effective date of February 1. Applicants who completed an application online, by phone, or in person can expect to receive a letter from MassHealth and the Health Connector about this coverage beginning the week of February 17. Those who submitted a paper application should allow additional time for processing. Please see these FAQs for updated information. Who is eligible to receive temporary coverage? Individuals are eligible to receive temporary coverage if:
How will people know if they have temporary coverage? All applicants who are or will be receiving temporary coverage will receive a letter from the Health Connector and MassHealth informing them about their temporary coverage. Keep this letter! Members will NOT be issued an ID card; this letter is their only proof of coverage. How can people in temporary coverage access services? Individuals receiving temporary coverage can seek services from any provider that accepts MassHealth. The letter that individuals will receive will contain a Member ID and should be presented when they get health care services. When will temporary coverage end? Temporary coverage will end when a full eligibility determination has been made. Applicants will receive another letter with their final eligibility determination. Commonwealth Choice Member Transition As a reminder, all of the Health Connector's Commonwealth Choice plans are ending by March 31, 2014 (if not sooner). Current members must enroll in a new health insurance plan to remain covered. To ease this transition, the Health Connector is notifying Commonwealth Choice members, who have not already applied for new coverage, of the most-similar Health Connector Qualified Health Plan, as recommended by their current carrier. Instructions on how to enroll in the suggested plan, as well as other health and dental plans offered by the Health Connector, will also be provided. This option is being called the Fast Path. To enroll using the Fast Path, Commonwealth Choice members will only need to pay the first premium bill, which will be sent to them if they take no other action. To shop for other plans, Commonwealth Choice members will be directed to the Health Connector website, where they can also apply online. If they opt to apply for subsidies, the process will take longer to receive a program determination. Remember: Open Enrollment Ends March 31! Don’t be confused! As noted above, while some subsidized plans that are being eliminated have been extended, the ACA Open Enrollment period for new coverage is still scheduled to end March 31. This applies to those seeking to enroll in ConnectorCare and Qualified Health Plans with or without a subsidy (MassHealth will continue to have rolling enrollment.). Addendum: While Open Enrollment ends March 31, the deadline to sign up and submit payment for coverage beginning April 1 is March 24. Enrollment between March 25 and 31 will be for coverage beginning May 1. Those who experience a qualifying life-event such as birth, marriage, loss of insurance, etc. can enroll outside of open enrollment. ConnectorCare may include new eligibility as a qualifying event. Editor’s note: Remember that Patient Financial Services is available to assist our patients. Patients who apply online themselves should be aware that there have been reports of problems with communication of enrollment information to the insurers. Those who do not receive timely communication that they have actually been enrolled should contact the Connector and/or the insurer directly. They should also keep careful records of any interactions with the Connector, including names of those they speak with, dates and times of interactions, and what they were told. See more information pertaining to this transitioning population. Health Connector Payments
The Connector is reporting that they have received some payments that do not correspond with enrollment data in their systems; likely leaving some uncovered who believe they are enrolled and have paid their premium.
What should you do to help prevent this from happening? When working with consumers, please ensure that they have completed the online application and plan selection and that they have fully "checked out." When sending payments, please remind members to:
-Adapted from e-mail: Important Updates from Health Connector and MassHealth: Commonwealth Care; Temporary Coverage; Commonwealth Choice Member Transition; and Health Connector Payments, MA Health Care Training Forum (MTF), February 15, 2014.
State Health Connector Website Woes Continue About 50,000 health insurance applications, many filed by low-income Massachusetts residents, have yet to be processed by the state’s troubled insurance marketplace, officials disclosed mid-month, and it may take months to get all these people enrolled in subsidized plans. Each application may represent a family or an individual. For several months, residents have been encouraged to file old-fashioned paper applications because the state’s insurance website has been hobbled by error messages and has crashed frequently since it was revamped in October to comply with the more complex requirements of the Affordable Care Act. Sarah Iselin, a health insurance executive whom Governor Deval Patrick recently put in charge of fixing the website, said the state is bringing in 300 people from Optum, a private contractor, to process the applications. The state is also working to develop a faster data-entry system, though that task alone could take three weeks, she said. Currently, it takes two hours to enter each application into a computer database. The website was working smoothly until it was overhauled by the tech firm CGI in a botched attempt to comply with the federal Affordable Care Act. Since then, the state has resorted to off-line workarounds and has put many people into temporary health plans. But an unknown number of other people may be uninsured because their applications have sat untouched. Iselin said another 32,000 people with insurance that is not subsidized and whose coverage expires March 31 are being mailed paper forms that will allow them to “sign, pay, and enroll” in plans that comply with the federal law, without having to use the faulty website. The state has also opened a command center in Quincy where state Medicaid officials and Connector staff are working with CGI and Optum, which was hired to make fixes. Iselin said staff are there around the clock, although she could not say when the website will be operating properly.
In the meantime, the Connector is operating a call center with 270 staff members fielding questions about insurance coverage from anxious residents, up from 65 several weeks ago. Earlier in the month officials announced that the Connector website should now be able to process eligibility determinations for a small group of new applicants that meet certain criteria. The system will also assign them a member identification number. Eligibility determination results will appear on the screen. The applicant will receive by mail a notice of his/her eligibility plus a plan selection notice The new functionality is currently available only for single individuals who are US citizens, who are not pregnant, disabled, or HIV positive, do not have breast or cervical cancer, and have no unearned income or children. Anyone who does not meet those criteria will continue to be processed manually.
-See the full Boston Globe article... Federal Health Care Site Can’t Fix Mistakes Tens of thousands of people who discovered that the federal HealthCare.gov website (i.e., from states that do not have their own exchange) made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors. About 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program, or denied them coverage entirely. As of early February, the appeals were sitting, untouched, inside a government computer. An unknown number of consumers are trying to get help through less formal means — by calling the health care marketplace directly. They are told federal workers do not have access to enrollment records to change them, according to individuals inside and outside the government who are familiar with the situation. A Centers for Medicare and Medicaid Services spokesman, Aaron Albright, said, ‘‘We are working to fully implement the appeals system.’’ Three knowledgeable individuals, speaking on the condition of anonymity about internal discussions, said it is unclear when the appeals process will become available. So far, it is not among the top priorities for completing parts of the federal insurance exchange’s computer system that still do not work. Those include an electronic payment system for insurers, the computerized exchange of enrollment information with state Medicaid programs, and the ability to adjust people’s coverage to accommodate new babies and other major changes in life circumstance. -See the full Boston Globe article... Obamacare Employer Mandate Eased The Obama administration this month granted employers another delay in a heavily criticized requirement that medium-to-larger firms cover their workers or face fines. In one of several concessions in a complex Treasury Department regulation of more than 200 pages, the administration said companies with 50 to 99 employees, about 2% of employers, will have an additional year to comply with the coverage requirement, until Jan. 1, 2016. The mandate was originally scheduled to start Jan. 1, 2014 but was delayed for one year last summer. For businesses with 100 or more employees, another 2% of employers, the requirement will still take effect in 2015. Once the employer mandate kicks in, companies with 50 or more workers must offer affordable coverage to their staffs or face penalties. Affordable insurance means that a worker doesn't have to spend more than 9.5% of his income on premiums for employee-only coverage. (The health reform law does not consider the affordability of family coverage.) Companies that don't provide insurance will be fined $2,000 per employee. But they will be subject to a $3,000 penalty if they don't offer affordable coverage and one of their workers buys a subsidized plan on the individual exchange. More than 90 percent of companies with 50 or more employees already cover their workers without the government telling them to do so, but the debate has revolved around the potential impact on new and growing firms. Companies with fewer than 50 people on staff, which make up 96% of businesses, are not subject to the Obamacare employer mandate. However, employer groups were also uneasy with a requirement that defines a full-time worker as someone averaging 30 hours a week. In Massachusetts, lawmakers last year repealed the state’s penalties for noncomplying employers in anticipation that the federal mandate would kick in on Jan. 1. After the Obama administration initially delayed implementation last summer, the state decided against restoring its penalties. The Obama administration still hasn’t issued rules for reporting requirements on business and insurers, the nitty-gritty of how the coverage requirement will be enforced. In other provisions the administration said:
Sources and for More Information
Medicare Reminder – When is it OK to Delay Enrollment? You typically have the seven months surrounding your 65th birthday to enroll in Medicare. However, if you are still working, Medicare may be either your primary or secondary insurance. If Medicare is secondary, you may be able to delay enrollment. The rules differ depending on whether you are eligible for Medicare due to age or disability. If you are eligible for Medicare due to age and work for a company that has 20 or more employees, your employer insurance is primary and Medicare is secondary. In this case, you may be able to delay your enrollment in Medicare. If you work for a company that has less than 20 employees, Medicare pays primary, so you will need to enroll when you are eligible. If you are eligible for Medicare due to disability and work for a company that has 100 or more employees, your employer insurance is primary and Medicare is secondary. In this case, you may be able to delay your enrollment in Medicare. If you work for a company that has less than 100 employees, Medicare pays primary, so you will need to enroll when you are eligible. A recent Reuters article emphasizes that even employers can get confused by this process. When deciding when to enroll in Medicare, it is important for a person to talk to both their employer’s human resources department andSocial Security or a third party expert. Keep records of who you talk to, when you talk to them, and what they say. If you do not enroll when you are supposed to, you may be subject to penalties or gaps in coverage. Learn more about how Medicare works with current employer insurance on Medicare Interactive. -Adapted from Medicare Watch, Volume 5, Issue 5, The Medicare Rights Center, February 06, 2014.
Medicare ACOs Find Considerable Savings and Quality Improvements The Centers for Medicare & Medicaid Services (CMS) recently released an update on key Medicare delivery system reforms, looking at analysis and results for various Accountable Care Organization (ACO) initiatives. ACOs are groups of doctors, hospitals and other health care providers who work together to provide high quality, coordinated care to people with Medicare. ACOs are meant to save money in the health care system by streamlining care and preventing medical errors and unnecessary duplications of services. In its interim findings on the Medicare Shared Savings ACO, CMS reports that 54 of the 114 ACOs that began operations in 2012 had lower expenses than projected in their first 12 months. Of these 54 ACOs, 29 produced a net savings of $128 million for the Medicare Trust Fund. While ACOs are meant to produce savings over several years and not annually, these initial figures show positive signs that results are in-line with projections for the first year of operations. A final report on ACO performance for the first year will be released later in 2014. In addition to the preliminary findings of the Medicare Shared Savings ACO, positive results for the Pioneer ACO Model and the Physician Group Practice Demonstration were also released. Read the CMS press release to learn more about these ACO initiatives. -Adapted from: Medicare Watch, Volume 5, Issue 5, The Medicare Rights Center, February 06, 2014.
Patients Need Training on New Health Insurance New Medicaid patients in Oregon failed to use their benefits effectively because they did not understand how to use insurance or health care, according to a study released recently in the journal Health Affairs. As a result, researchers told USA TODAY, patients did not receive preventive health screenings, schedule appointments to manage chronic illnesses or use their new insurance coverage for anything beyond medical emergencies. "There's this idea that health insurance is like car insurance: You use it when something really bad happens," said lead author Heidi Allen, an assistant professor at the School of Social Work at Columbia University and one of the co-investigators in the Oregon Health Insurance Experiment. Allen found in her review of in-person surveys of 120 new enrollees that:
"This is a good opportunity to socialize people who may not have had health care for a really long time about how we want them to use health care," Allen said of her findings. "I see an opportunity for us to help patients understand, 'When this happens, this is where we want you to go.'" -See the full USA Today article... Critics Call for Tamper-Resistant Opiates For Detective Sergeant Charles Peterson of the Yarmouth Police Department, one of the most frustrating aspects of prescription opiate abuse is that so much of the epidemic could be prevented. The pharmaceutical industry has developed pills that are strongly resistant to being crushed — and are therefore difficult for addicts to abuse. But industry profit margins, battles over patents, caution over a still-emerging technology, and a ponderous federal bureaucracy have kept such abuse-resistant pills from widespread adoption in the market. Peterson, a 20-year veteran of narcotics enforcement, is among the supporters of proposals in Congress to require that drug companies market only abuse-resistant versions of oxycodone and other prescription opiate pain-relief pills. Advocates say the need to curb abuse of prescription opiates — considered gateway drugs to heroin — is all the more urgent because of a growing epidemic of heroin addiction and overdoses in Massachusetts and across the country. Currently the federal Food and Drug Administration allows one painkiller — an expensive reformulation of the brand-name OxyContin — to be marketed as abuse-resistant. Meanwhile, other opiate medications, ubiquitous on pharmacy shelves and widely prescribed, are easily pounded into powder for snorting or dissolved for injection. Drug companies that make the cheaper generic forms of oxycodone and other painkillers are resisting the proposed changes in Washington. Critics say the industry needs to be forced to comply. The debate is complicated by the rules around drug patents. Generic manufacturers win access to markets once the patent on a brand-name drug expires. Typically, that is a positive thing for consumers because it dramatically lowers the costs of prescription drugs. But in the case of addictive substances, say advocates of the bill, cheaper generics have the potential to cause more harm than good. -See the full Boston Globe article... U.S. Drug Czar Urges Police to Carry Heroin Overdose Treatment ; Boston Planning to Implement The Obama administration recently urged more local police and fire departments to equip their personnel with a medication used to revive people who have overdosed on heroin, citing a troubling increase in deaths from the drug. Naloxone a blocking agent that can reverse the effects of an overdose and help restore breathing, has been used by law enforcement and first responders in some cities and municipalities, but its use needs to be expanded, U.S. drug officials said. "Naloxone can save lives," the White House's Office of National Drug Control Policy said in a statement. "Because police are often the first on the scene of an overdose, the Obama administration strongly encourages local law enforcement agencies to train and equip their personnel with this lifesaving drug," said Gil Kerlikowske, the office's director. Heroin use has jumped by 80% in recent years, drug control officials said, with 669,000 Americans saying they had used the drug in 2012, up from 373,000 in 2007. But it is still rare compared to other substance abuse, Kerlikowske told reporters in a conference call. Data show prescription opioid painkiller abuse far outpaces heroin. About 12.5 million people abused prescription opioids in 2012 U.S. government data shows. About 3,000 people died from heroin overdose in 2010 compared to more than 16,600 deaths from opioid painkiller overdose. Officials acknowledged a link between the use of prescription painkillers and heroin."There is evidence to suggest that some users eventually begin to substitute pills with heroin, which is often cheaper than prescription drugs," Kerlikowske said. Earlier this month Boston Mayor Martin Walsh called for all first responders in Boston to carry the medication. All emergency medical technicians and paramedics from Boston EMS already carry the medication and have used it to reverse numerous overdoses. Walsh said he wants the Boston Public Health Commission to train Boston police and firefighters so that all first responders have access to the medication. Sgt. Michael McCarthy, a spokesman for the Boston Police Department, said he expects the proposal will be discussed with leaders from the city’s three police unions. “Discussions are planned with them, but we’re pretty confident that it’s going to be implemented,” McCarthy said. Prosecutor Calls for Over-the-Counter Availability In a parallel effort, the top prosecutor in Norfolk County is calling on federal regulators to make naloxone available without a prescription to get it in the hands of more first responders and family and friends of addicts. District Attorney Michael Morrissey said that would allow more people to get access the drug, which has been used to revive hundreds of overdose victims on the South Shore since 2010. He relayed that message to White House drug czar R. Gil Kerlikowske at a recent meeting at a Taunton fire station to discuss the growing problem of heroin and overdoses. Firefighters had to leave in the middle of the meeting to respond to a possible overdose. 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Culinary Culprits: Foods That May Harm the Brain For all the attention paid to the negative effects poor dietary choices have on the body, the effects of diet on the brain are largely unexplored. However, emerging research is providing new insights to support the suggestion that food can have a profound influence on mental health and cognition. From sugar and carbohydrates to fats and even, according to one controversial theory, whole grains, the list of dietary choices having potentially negative effects on the brain is growing by leaps and bounds. And although the big caveat for the bulk of evidence is that most studies show an association with but not necessarily causation of mental health and cognitive deficits, many clinicians report seeing first-hand improvement in patients' mental health outcomes with the tweaking of a diet to eliminate some of the most notorious culinary culprits. "While we don't want to send the message to patients that all they have to do is change their diet and their severe depression will be cured, I can say that I have absolutely seen dietary changes work to improve outcomes for a lot of patients, and there are a lot of reports of that," said Drew Ramsey, MD, an assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons in New York City. Dr. Ramsey, the author of The Happiness Diet: A Nutritional Prescription for a Sharp Brain, Balanced Mood, and Lean, Energized Body (Rodale, 2011) and Fifty Shades of Kale (HarperWave, 2013), asserts that the role of diet, so strongly emphasized in general practice, is simply too commonly overlooked in mental health practice. "If someone has a severe mental illness, it is very important to talk to them about diet," he told Medscape Medical News. For example, he said, if a patient has certain nutrient deficiencies, it will be difficult for any medications to help until such deficiencies are treated. -See the full article: Culinary Culprits: Foods That May Harm the Brain. Medscape. Jan 30, 2014.
A Little Extra Sugar Tied to Fatal Heart Disease in Study The biggest study of its kind suggests that sugar can be deadly, at least when it comes to fatal heart problems. It doesn’t take all that much extra sugar, hidden in many processed foods, to substantially raise the risk, the researchers found, and most Americans eat more than the safest amount. "Yang et al... (show) that the risk of CVD mortality becomes elevated once added sugar intake surpasses 15% of daily calories—equivalent to drinking one 20-ounce Mountain Dew soda in a 2000-calorie daily diet," Dr Laura A Schmidt (University of California, San Francisco) writes in an invited commentary. The risk rises exponentially as sugar intake increases, peaking with a fourfold increased risk of CVD death for individuals who consume one-third or more of their daily calories in added sugar, she adds. Previous studies have linked diets high in sugar with increased risks for nonfatal heart problems, and with obesity, which can also lead to heart trouble. But in the new study, obesity didn’t explain the link between sugary diets and death. That link was found even in normal-weight people who ate lots of added sugar. For most American adults, sodas and other sugary drinks are the main source of added sugar. Scientists aren’t certain exactly how sugar may contribute to deadly heart problems, but it has been shown to increase blood pressure and levels of unhealthy cholesterol and triglycerides; and also may increase signs of inflammation linked with heart disease, said Rachel Johnson, head of the American Heart Association’s nutrition committee and a University of Vermont nutrition professor. Yang and colleagues analyzed national health surveys between 1988 and 2010 that included questions about people’s diets. The authors used national death data to calculate risks of dying during 15 years of follow-up. Overall, more than 30,000 American adults aged 44 on average were involved. Sources and For More Information
Study Finds Telemedicine Can Decrease Nursing Home Hospitalizations A recent Commonwealth Fund-sponsored study suggests that the use of telemedicine in nursing homes can help reduce hospitalizations of nursing home residents. A lack of physicians on call after hours and on the weekends causes many nursing home residents to be sent to the hospital for treatment if they need care outside of regular hours, even if they could be treated outside of the hospital. These unnecessary hospitalizations increase the resident’s likelihood of experiencing negative health incidents or even death. This study investigates one potential solution to the lack of physicians on call for nursing homes—telemedicine. Telemedicine allows patients to virtually “visit” with a physician using technology. For example, some telemedicine models allow the patient to meet with the doctor through a two-way video. Reduced hospitalizations are equivalent to better health for residents, as well as increased Medicare savings. The study calculated that, based on the savings in the “more engaged” nursing homes, Medicare could save about $120,000 per nursing home per year when the cost of telemedicine technology is taken into account. The study recommends that Medicare create financial incentives for nursing homes to implement telemedicine with staff support. Some new health care delivery models, such as ACOs, allow facilities to share in savings and already encourage use of telemedicine. Medicare can further encourage telemedicine adoption in nursing homes by continuing to support existing and new innovative health care delivery models. Read Commonwealth’s summary of the study. -Adapted from: Medicare Watch, Volume 5, Issue 6, The Medicare Rights Center, February 13, 2014. |