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MGH Community News |
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MGH Community News |
| June 2014 | Volume 18 • Issue 6 |
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. |
Social Security Closes Offices as Demand is on Upswing Budget cuts have forced the Social Security Administration to close dozens of field offices as millions of baby boomers approach retirement, swamping the agency with applications for benefits, a senior agency official told Congress this month. The Aging Committee held a hearing Wednesday after issuing a bipartisan report showing that Social Security has closed 64 field offices since 2010, the largest number of closures in a five-year period in the agency’s history. In addition, the agency has closed 533 temporary mobile offices that often serve remote areas. Hours have been reduced in the 1,245 field offices that are still open, the report said. As a result, seniors seeking information and help from the agency are facing increasingly long waits, in person and on the phone, the report said. Further, the report says that demand is up. About 43 percent of those seeking an appointment had to wait more than three weeks, up from just 10 percent the year before. Better Internet access and more online services are easing the transition, said Nancy Berryhill, the agency’s deputy commissioner for operations. Senators appeared unconvinced. ‘‘The fact of the matter is, millions of seniors and disabled Americans are not accustomed to doing business online,’’ said Senator Susan Collins of Maine, the top Republican on the Aging Committee. ‘‘Even as computer and broadband technologies become more widespread, the idea that the Social Security Administration can serve beneficiaries primarily online ignores the very real needs of the senior and disabled populations.’’ [MGH Community News note: additionally, one cannot apply for Supplemental Security Income (SSI) online.] ‘‘They don’t do any kind of analysis on what would happen to a community when their field office closes, including figuring out how the most vulnerable populations would make their way to the next-closest office,’’ said Senator Bill Nelson, Democrat of Florida, chairman of the Aging Committee. The closings come as applications for retirement and disability benefits are soaring, a trend that will continue as aging baby boomers approach retirement. More than 47 million people receive Social Security retirement benefits, nearly a 20 percent increase from a decade ago. About 11 million people receive Social Security disability benefits, a 38 percent increase from a decade ago.About 10 percent of visitors to Social Security offices are applying for benefits, Berryhill said. The largest group, about 30 percent, are seeking new or replacement Social Security cards. Like many federal agencies, Social Security has faced budget cuts in recent years. After two years of shrinking budgets, the agency got a 6 percent increase this year. Social Security has cut its workforce by 11,000 employees over the past three years, Berryhill said. -See the full Boston Globe article... |
State Filings for Custody of Children Soaring The state’s child welfare agency has intensified efforts to remove children from troubled homes since preschooler Jeremiah Oliver was reported missing in December, a dramatic shift that critics say has put more strain on an already overburdened system. From December through May, the state Department of Children and Families filed nearly 2,000 court petitions to gain custody of children they determined to be at risk of abuse or neglect, a 52 percent increase from the previous year, according to court statistics. Last month, the agency filed 365 such petitions, a 70 percent jump from May 2013. Child advocates say the surge marks a clear response to criticism of the agency following the Oliver scandal, which led to the resignation of commissioner Olga Roche in April. Many describe the jump in custody petitions as an overreaction to intense public scrutiny that will needlessly send more children into foster care. With more children being taken from their homes, social workers are scrambling to place them in foster care. And with so many cases, lawyers who represent parents seeking to keep custody of their children are in short supply, and hearings cannot be heard within three days as legally required. High-profile deaths of children under state supervision typically spur a more cautious approach, at least in the short term. But this increase has been more pronounced and sustained, those who work with children say. The increase in petitions filed to gain custody of children stands in marked contrast to recent years. Between 2008 and 2012, the number fell 30 percent, part of an effort to keep families together whenever possible. In May, the state’s child advocate office cited that philosophy in a report concluding that DCF erred by leaving a Lynn infant in a deeply troubled home, where he was fatally beaten, allegedly by his mother’s drug-addicted boyfriend, in July 2013. “Many felt that a shift in values had occurred and DCF was no longer taking custody of children when the agency should have done so and that children were remaining in their homes when they should have been removed to foster or kinship care,” the report found. Under Roche, the agency sought a more balanced approach, advocates said. But Gail Garinger, the state’s child advocate, said the recent surge suggested the pendulum had swung too far in the other direction. Susan Elsen — attorney for the Massachusetts Law Reform Institute, which keeps a close watch on DCF — said investigations of abuse and neglect climbed 67 percent between January and March. But heavier caseloads make it harder for social workers to determine when parents can no longer safely care for their children and to work with troubled families to help keep them stable. “It’s important that you don’t let these increases spiral out of control,” she said. “You want to avoid separating children from their families whenever possible.” -See the full Boston Globe article...
HomeBASE (Housing Assistance) Recipients at End of Benefits May Be Eligible for EA Family Shelter Recipients of Massachusetts’ HomeBASE housing assistance funds who have reached the end of their 24-month subsidy and cannot afford to maintain their housing may be eligible for Emergency Assistance (family Shelter) and may not be subject to some of the stricter rules/processes that apply to other applicants. They may receive a waiver allowing them to access EA without waiting for an eviction. If they apply within 30 days from the last day of their benefit, they may receive a waiver that allows expedited processing of their applications without having to appear in person at the DTA office. Those who left EA for housing under HomeBASE Housing Assistance on or after December 11, 2013 will receive a waiver of the 12 month bar on receiving EA assistance, as long as it has been at least 3 months since receiving EA. These rules have been simplified. For detailed information see:
Unemployment System Reportedly Working; Uncovers Fraud The state Department of Unemployment Assistance (DUA) says it has uncovered a fraudulent scheme involving nearly 600 false claims for unemployment checks since the beginning of March. Under a system developed by Deloitte Consulting, the DUA started requiring displaced workers to file their initial claims online last July. Numerous defects were found in this system, some of them prompting delays in the delivery of unemployment funds that were owed to people. Rachel Kaprielian, the state’s secretary of labor and workforce development since January, says that while there are still some issues, there are no large-scale problems remaining with the unemployment insurance system’s online functions. The fraud discovered represents a major test of the new computer system. Both Kaprielian and Michelle Amante, the DUA’s director, say that the system is more secure, not less, since the online process was started last summer. They say that’s because of all the new data available at a keystroke to DUA officials, and how that information can be crosschecked now with other databases such as the Department of Revenue’s. The agency now has the capability to quickly check massive amounts of data for patterns that could indicate fraud. Kaprielian says the new computer system caught more than 500 of those claims before a check went out the door, providing the unemployment insurance system with as much as roughly $9 million in savings when spread out over the maximum 30 weeks of benefits. (State officials say roughly 61,000 claims have been filed since early March.) In each of the 600 cases, the claims were fraudulently filed on behalf of a real person who had no idea someone was using their identity to gather unemployment checks. The DUA’s system of checking with employers, for example, determined that many of these people that were supposedly filing for claims actually hadn’t lost their jobs. “It could have happened under the old system, but it would have been nearly impossible to detect,” Kaprielian says of the fraud. -See the full Boston Business Journal article... Massachusetts has Backlog of Death Certificates Long delays from the state medical examiner's office in issuing death certificates are putting an additional strain on many grieving families and making it more difficult to settle estates and process insurance claims. The Massachusetts Executive Office of Public Safety, which oversees the office, says the number of unfinished death certificates soared from 58 in 2011 to 947 in 2013, according to a report in The Boston Globe. Under state law, the medical examiner must conduct autopsies and determine the cause of unattended deaths, homicides, suicides, deaths in custody and deaths of infants. The national medical examiners' association recommends autopsy reports be completed within 90 days. In Massachusetts, it often takes twice as long. The backlog appears to have multiple causes, including a shortage of pathologists. The medical examiner's office has 10 doctors to handle nearly 2,500 autopsies annually. A 2007 study recommended at least 17 doctors. Also, in a move to save $600,000 annually, the medical examiner changed the laboratory that conducts toxicology testing, delaying results for months. Help may be coming. Gov. Deval Patrick proposed adding $2 million to the medical examiner's $10 million budget for next year, and the House and Senate have included similar amounts in their budget plans. That would help by adding more doctors and support staff who can handle the paperwork backlog.
-See the full South Coast Today article... Bridgewater State Hospital- Surprise Joint Commission Inspection; Governor Releases Plan The agency that accredits hospitals, prompted by what it called “patient safety concerns,” conducted a surprise inspection of troubled Bridgewater State Hospital late last month and gave the facility 45 days to respond to the findings or risk losing accreditation. Despite its name, Bridgewater is a medium-security prison housing about 280 men involved with the criminal justice system who are diagnosed as mentally ill. The Joint Commission has granted the facility accreditation as a behavioral health care provider, not as a hospital. The Joint Commission did not specifically identify its concerns in its public statements, but the Globe has reported that Bridgewater clinicians and prison guards have routinely used seclusion and restraints to control patients diagnosed as severely mentally ill, often in violation of state law, regulations, and Bridgewater’s own policies. The Joint Commission’s standards say that seclusion and restraints “pose an inherent risk to the physical safety and psychological well being of the individual served” and should be used “only in an emergency where there is an imminent risk of an individual served physically harming herself or himself or others.” Roderick MacLeish Jr., an attorney who has filed a class-action lawsuit on behalf of patients at Bridgewater who are not serving criminal sentences, said he welcomed the Joint Commission’s visit. Further he suggested that the commission should also review why Bridgewater is housing developmentally disabled patients and other severely ill patients. “Bridgewater is no place for autistic, mentally retarded, or chronically mentally ill patients not convicted of crimes,” MacLeish said. After the Joint Commission receives and evaluates a response from the Department of Correction, it may take a variety of actions, ranging from accreditation to outright denial of accreditation, which would severely damage Bridgewater’s reputation. The Governor’s Plan Also this month, Governor Deval Patrick unveiled an ambitious and potentially costly plan to reform the way the state’s criminal justice system handles mentally ill people, proposing a dramatic increase in staff at troubled Bridgewater State Hospital and a new facility where potentially violent patients could receive care. The plan, expected to cost $12.3 million in the short term and far more over the long term, calls for Massachusetts to move away from treating mentally ill people as prisoners and more like patients, including better training for staff at Bridgewater State Hospital to reduce the use of seclusion and restraints, which was blamed for the death of a young mental health patient in 2009. The proposal would move many patients at Bridgewater, a medium-security prison, to less restrictive facilities. It declares that mentally ill people “should receive the appropriate care in the appropriate setting.” At least 100 of the 300 inmates at Bridgewater are being held there while awaiting trial and are not serving criminal sentences. State Representative Kay Khan, a Newton Democrat who is a longtime advocate of improving treatment for the mentally ill in the criminal justice system, praised Patrick’s initiative, but said proponents will have to work hard to win legislative support for such a potentially costly plan. “I don’t think the Legislature is just going to jump up and do it,” she said. “We’re going to have to educate legislators about the need for this.” -See the full Boston Globe articles:
Early Voting Coming to Massachusetts Massachusetts is joining 32 other states that allow voters to cast their ballots before Election Day. Gov. Deval Patrick recently signed a package of reforms aimed at increasing voter participation. The bill includes provisions for early voting, pre-registration for 16- 17-year-olds, online voter registration and post-election audits of voting machines. The early voting provision, which will go into effect for general elections beginning in 2016, will allow in-person early voting up to 11 businesses days before the election. Another component of the bill will end the practice of removing people from the active voter rolls the first time they fail to fill out their annual census. -See the full Mass Political News article... Cited in/linked from MASSterList, Mike Deehan, June 25, 2014.
Personal Finance- Financial Education Resources Financial education programs teach people how to manage money, increase savings, protect assets, and work towards financial security. Most financial education programs are free for area residents. Many programs are open to anyone who wants to learn about money management. Other programs are for specific target groups such as teens, homebuyers, or retirees. Financial education may include a wide variety of money-related topics such as:
Source: http://www.massresources.org/financial-education.html (As of March 2015 website no longer operational.) Some Program Highlights Include:
-Program highlights from contributors to the Mass. UtilityNetwork listserv. Charles River Public Internet Center The Charles River Public Internet Center is a community technology center that welcomes all who need access to computers, the Internet, and training. They provide the general public with untimed access to 20 computers and the Internet for a suggested donation of $1.00. Their professional staff is available to provide free, informal assistance on an as-needed, as-available basis to any Center patron. CRPIC is fully licensed by the Massachusetts Department of Education and provides free one-on-one tutoring and low-cost courses. CRPIC is an ADA compliant, handicapped accessible facility. They are open to the general public between 12 pm and 8 pm, Monday through Thursday. One-On-One Tutoring - CRPIC offers members of the community free, one-on-one tutoring with a scheduled appointment for a half or full hour session. Priority scheduling goes to those with little computer experience. Tutors are students from local colleges and volunteers from the community and hi-tech industry. Typical tutoring topics include setting up and using email accounts, learning to navigate the Web, understanding how to set-up and save files, and using Microsoft Office applications such as Word, Excel, and PowerPoint. Most tutors will gladly explore other reasonable topics with advance notice. Patrons are eligible for four or more free sessions per year depending upon the availability of appointments. Call for availability and scheduling information, 781-891-9559, x206. Classes are also available in Spanish and Haitian Creole. Additional classes and services offered throughout the year may include financial literacy, ESOL and tax preparation assistance. Adapted from, and for more information: http://www.crpic.org/
Transgender Health Care Coverage Gets Big Boosts In dramatic turnarounds both Medicare and MassHealth will now cover medically indicated services for those with gender dysphoria. The state also moved to prohibit private insurers from denying coverage for gender reassignment surgery or other treatments medically necessary for patients who are transgender, saying that would constitute sex discrimination. The Patrick administration will strongly recommend similar reforms to the Group Insurance Commission, which provides coverage for thousands of state and municipal employees and their dependents. Medicare This month the Department of Health and Human Services (HHS) Department Appeals Board (DAB), an independent federal appeals board, ruled that Medicare must cover medically necessary care for individuals with gender dysphoria, just as it covers medically necessary care for those with other medical conditions. In short, Medicare will now cover transition-related care for transgender older or disabled adults. In 1989, Medicare adopted a National Coverage Determination categorically excluding what it called “Transsexual Surgery” from Medicare coverage regardless of a person’s individual medical conditions and needs. The appeals board decided an appeal from a Medicare beneficiary and declared that the 1989 exclusion was based on outdated, incomplete, and biased science, and did not reflect standards of care. This means that decisions about coverage for transition-related care will now be made on an individual basis like all other services under Medicare.
In a statement on their website, Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) said that “the ability to access complete gender-transition related health care is essential to ensuring the health and well-being of transgender patients.” The statement continues: -Thanks to Melanie Cohn-Hopwood for sharing this news. MassHealth and Other Massachusetts Coverage Massachusetts this month became the third state in the nation (behind California and Vermont) to cover transgender medical services, including gender reassignment surgery, as a standard benefit in its government health plan for lower-income and disabled people (MassHealth). In the coming weeks, MassHealth will publish proposed regulations for public comment to extend health care coverage to provide medically necessary treatment for gender identity or gender dysphoria including hormone therapy and gender-reassignment surgery. The administration of Governor Deval Patrick also moved to prohibit private insurers from denying coverage for gender reassignment surgery or other treatments medically necessary for patients who are transgender, saying that would constitute sex discrimination. To date five other states (California, Colorado, Connecticut, Oregon and Vermont) and the District of Columbia have expressly prohibited such exclusions in many or all private plans. The Patrick administration also is strongly recommending similar reforms to the Group Insurance Commission, which provides coverage for thousands of state and municipal employees and their dependents. And in extending coverage for gender reassignment treatments to employees, Massachusetts follows the State of California as well as municipal governments in San Francisco; Seattle; Portland, Ore.; and the District of Columbia, Cray said, as well as more than 200 private-sector employers. And earlier this month, the Boston City Council unanimously supported an ordinance that guarantees access to gender reassignment surgery, hormone therapy, and mental health services for municipal employees and their dependents who are transgender. The Williams Institute, a think tank at the University of California, Los Angeles School of Law that researches sexual orientation and gender identity law and public policy, estimated in 2011 that 0.3 percent of adults in the United States were transgender, which would amount to about 20,000 people in Massachusetts. Sources and for More Information
Medicare, Social Security & the Overturn of DOMA - Where Do We Stand? A year ago the U.S. Supreme Court struck down the Defense of Marriage Act. The court's recognition of marriage equality has transformed life for many same-sex couples. In the realm of retirement benefits, the DOMA ruling opened the door for couples to receive spousal benefits from our two most important social insurance programs, Social Security and Medicare. Since the ruling, Social Security and Medicare have made substantial changes that benefit same-sex married couples. But there have been complications. The ruling quickly cleared the way for same-sex couples to be recognized for purposes of federal benefits in cases where couples were married in, or are living in, a state recognizing gay marriage. Most Medicare benefits have also been extended to married couples no longer living in states permitting same-sex marriage. But Social Security hasn’t yet extended benefits to states that don’t permit same-sex marriage because the Social Security Act's definition of a spouse relies on the definitions in the state where an applicant lives. Here’s where Social Security and Medicare stand a year after DOMA. Social Security The Social Security Administration is processing spousal and survivor claims for benefits in states recognizing same-sex marriage. Meanwhile, the SSA took an additional incremental step recently as part of a broader federal initiative to extend a wide array of benefits to same-sex couples. It announced that spousal benefits will be extended to married couples living in states that don’t recognize same-sex marriage but have laws that recognize an inheritance right for a same-sex spouse - for example, states that permit civil union or domestic partnership. In the meantime, experts advise same-sex couples who think they may be eligible for benefits to file for Social Security. That step could qualify couples to receive retroactive benefits if, and when, the state-of-residence issue is resolved. Gay & Lesbian Advocates & Defenders (GLAD), which played a key role advancing litigation that led to the Supreme Court decision, has published an in-depth guide to benefits for same-sex couples that addresses many key questions about Social Security (bit.ly/1ysmcE2). Medicare
Medicare isn’t legally bound by state-of-residence restrictions, so its same-sex reforms have been more extensive than those made by Social Security.
Joint-filing couples could also face Medicare's high-income premium surcharges for Part B and Part D in cases where one spouse's income is high. *People who live in states that don't recognize same-sex marriage, but were married elsewhere, have access to all the above-mentioned with one wrinkle: You cannot get premium-free Part A based on your spouse's work history unless you are in a civil union or domestic partnership and living in a state that recognizes inheritance rights. (This policy was revised in mid-June as part of the latest round of federal rule changes.) The rules around which relationships in which states count are complicated, so if you think you might be entitled to benefits, you should apply. And all else failing, you may be able to get a reduction in the amount of the Part A premium. A Q&A on Medicare benefits for same sex married couples is available at SAGE USA (bit.ly/1sAfOdz) -See the full Reuters story... Cited in/linked from: Medicare and the Windsor Decision: Where Do We Stand?, Medicare Watch, The Medicare Rights Center, June 26, 2014.
Medicare Reminder: Rehab Coverage Is Now Available for Chronic Conditions- Improvement Standard Overturned Medicare beneficiaries receiving skilled care for chronic conditions, no longer have to show improvement in order to have the care covered, but providers (such as a doctor, home care agency, or nursing home) may not know this. Even though a recent lawsuit settlement mandated a nationwide educational campaign for providers, many are still refusing to provide needed treatment, believing that Medicare will not cover it. For about 30 years, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. Under a settlement agreement in Jimmo v. Sebelius (approved in January 2013), the federal government agreed to update Medicare rules to require that Medicare cover skilled care as long as the beneficiary needs skilled care, even if it would simply maintain the beneficiary's current condition or slow further deterioration. The policy shift affects beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke. In addition, under the settlement Medicare beneficiaries who received a final denial of Medicare coverage after January 18, 2011 (the date the lawsuit was filed) are entitled to a review of their claim denial. The government launched an educational campaign in January to explain the settlement and the new rules to Medicare providers like home care agencies and nursing homes, but according to a Reuters article, many providers remain unaware of what is covered or how to bill Medicare for the services. The campaign was not aimed at beneficiaries, so not all Medicare beneficiaries are aware of the rules and that they can fight a denial of coverage. The Center for Medicare Advocacy has several self-help packets explaining how to appeal improvement standard denials.
-Adapted from, and for more information see, ElderLawAnswers.com. Medicare Reminder: Eye Care Coverage In most cases, Medicare will not pay for routine eye care. However, remember, there are two different coverage options for people with Medicare. People with Medicare can either get their Medicare benefits through Original Medicare, the traditional Medicare program administered directly through the federal government, or through a Medicare Advantage plan, also known as a Medicare private health plan. Original Medicare Under Original Medicare, Medicare will generally not pay for routine eye care. However, Medicare can make an exception and pay for routine eye care in the following situations:
Medicare may also pay for eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Specifically, Medicare can cover cataract surgery, as well as eye exams to diagnose potential vision problems. Medicare generally does not cover eyeglasses or contact lenses, unless you have had cataract surgery. Original Medicare may cover one pair of eyeglasses or one set of contact lenses if you need them after cataract surgery. Medicare Advantage Medicare Advantage plans may offer more vision coverage than Original Medicare. Keep in mind, however, that most plans generally offer limited vision coverage. If you have a Medicare Advantage plan, contact the plan directly to learn more about the plan’s benefits, costs and rules. -Adapted from Does Medicare cover routine eye care?, Dear Marci, Medicare Rights Center, June 16, 2014. New CMS Guidance on Medicare Part D vs. Hospice Coverage The Center for Medicare & Medicaid Services (CMS) has issued new guidance directing Part D drug plans to require prior authorization for all prescription drugs for hospice beneficiaries. Once Medicare beneficiaries elect hospice, the hospice provider is supposed to cover drugs prescribed for the terminal condition or related complications. Part D plans are supposed to cover drugs for conditions unrelated to the terminal illness. In the past, the proper entity has not always covered the drugs; therefore, CMS has issued guidance encouraging Part D plans to require prior authorization for all drugs once a person elects hospice care. The Medicare Rights Center and 26 other advocacy organizations recently sent a letter to urge CMS to bring together stakeholders to find a solution that ensures the appropriate entity pays for the drugs, while making sure the hospice beneficiary is not put in the middle of any disputes and unable to get their medications. The advocates state that this guidance is premature and should be suspended for multiple reasons. First, the guidance places the burden on terminally ill beneficiaries to make sure the correct entity is billed, instead of on the Part D plans and hospice providers. Second, beneficiaries are not typically provided with clear information about how to proceed if their drug is denied at the pharmacy. Third, it requires these beneficiaries to navigate the confusing – and often inefficient – Part D appeals process. Finally, these barriers can cause terminally ill beneficiaries to go without needed medications, or pay for them out-of-pocket unnecessarily. The advocates strongly encourage CMS to delay this guidance until stakeholders have created a suitable alternative that does not place the burden on terminally ill Medicare beneficiaries.
-Adapted from Advocates Ask CMS to Suspend New Part D and Hospice Guidance, Medicare Watch, June 19, 2014. Extension Approved for Commonwealth Care and Temporary Coverage and Website Update Coverage Extensions The Commonwealth has received approval to extend both the Commonwealth Care (CommCare) and Temporary Coverage (through MassHealth FFS Standard and Limited) programs through December 31, 2014. Members currently enrolled in these health insurance programs should have received notification of this extension by mail. Premium paying members enrolled in Commonwealth Care must continue to pay their premium bill in full and on time in order to remain in this coverage. Members enrolled in Temporary Coverage do not need to take any action at this time to continue to access this coverage. As you know, the Health Connector and MassHealth have had technical problems with their new website, which has prevented them from being able to issue program determinations to applicants. They have extended both programs to ensure that members keep health insurance while they work to resolve these technical issues. Members will get more information in the future letting them know about any next steps they will need to take. Until that time they will continue to keep Commonwealth Care, if they still qualify and continue to pay their premiums, or Temporary Coverage through December 31, 2014 or until we process their application. If a member has any questions about their Temporary Coverage, they should contact MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled). Commonwealth Care members may contact the Health Connector's Commonwealth Care Customer Service Center at 1-877-623-7773 with any questions about their current coverage. Website Update Meanwhile, an assessment of the new software for the Massachusetts Health Connector website, set for early July, will provide the first read on whether the state is likely to succeed at running its own health insurance marketplace in 2015 or will default to the federal system. The original website was intended to be “one stop shopping” for anyone seeking coverage from MassHealth, Health Safety Net, or the Connector. The Connector announced last month it would scrap the trouble-plagued software. The plan is to abandon the idea of “one stop shopping” for now and create separate processes for MassHealth/Health Safety Net and the Connector products (ConnectorCare and commercial Qualified Health Plans with or without federal subsidies). For the Connector products, the state is pursuing a “dual track,” working to adapt software used in other states (a program called hCentive) for Connector product applications, while preparing to join the federal Healthcare.gov insurance marketplace in case that effort fails. MassHealth and Health Safety Net applications will use a combination of a stripped down version of the current website and the legacy system. The “critical checkpoint” with the US Centers for Medicare & Medicaid Services in July will start to clarify the most likely route for the Connector products. If state and federal officials conclude that the state-based website is progressing well, the Connector will continue on the dual track. If not, it will focus on preparing to join the federal marketplace for one year. The temporary Medicaid program has enrolled 227,374 people whose eligibility could not be verified. Glen Shor, Connector board chairman and state secretary of administration and finance, estimated that 99 percent of those enrollees are in fact eligible for either subsidized insurance coverage or Medicaid. Lora Pellegrini, president of the Massachusetts Association of Health Plans, said that many of the people temporarily enrolled in Medicaid probably belong in private coverage, paying premiums. Additionally they are all in fee-for-service Medicaid, missing out on disease management programs that managed-care plans provide. “That’s why we think it’s important to get those folks into permanent coverage as soon as possible,” she said. He told the board that despite the inability to enroll people in the expected programs, the aggregate spending “closely matches” budget projections. Neither MassHealth (the state’s Medicaid program) nor the Connector will need to ask the Legislature for additional money to cover care, Shor said. While Connector officials expressed optimism about their progress with hCentive, preparations to join the federal marketplace are also moving along smoothly, Ashley Hague, deputy executive director, told the Connector board. The only glitch with using Healthcare.gov is an inability, so far, to provide state subsidies along with federal subsidies, she said. The hCentive software is able to integrate the state subsidies. Adapted from and for More Information
-Additional material from Affordable Care Act: implementation updates, e-mail correspondence, Kim M. Simonian, Director for Public Payer Patient Access, Partners HealthCare - Community Health, May 20, 2014. Update on Temporary Coverage Under “MassHealth Limited” MassHealth has implemented a process to provide temporary MassHealth Limited coverage to individuals who are ineligible for the temporary coverage program due to lack of immigration status. Individuals who newly apply for coverage and are otherwise qualified for temporary coverage except for their immigration status will be provided MassHealth temporary Limited coverage until we are able to make a final ACA program determination. If an individual completes a paper application, coverage will begin on the 1st of the month the application was received. If an individual completes an online application, coverage will begin on the 1st of the month the application was submitted. Limited coverage will last until December 31, 2014 (unless temporary coverage is further extended) or they are able to make a final decision on the application. Benefits are the same as under regular MassHealth Limited: You can get care only for medical emergencies (conditions that could cause serious harm if not treated):
Written notice will be sent to those who are found eligible for MassHealth temporary limited coverage: sample notice. -Adapted from Update on Temporary Limited Coverage, MA Health Care Training Forum, June 11, 2014 and the sample notice.
Report: Social Security Judges Rubber-Stamp Claims Amid complaints about lengthy waits for Social Security disability benefits, congressional investigators say nearly 200 administrative judges have been rubber-stamping claims, approving billions of dollars in lifetime payments from the cash-strapped program. Four of the judges defended their work at a combative congressional hearing this month. They said they follow the law. ‘‘I’ve seen their ailments, I’ve seen their pain, right in front of me,’’ Judge Gerald I. Krafsur of Kingsport, Tenn., told the House Oversight Committee. The hearing comes as Social Security’s disability program edges toward the brink of insolvency. The trust fund that supports the disability program is projected to run out of money in 2016. At that point, the system will collect only enough money in payroll taxes to pay 80 percent of benefits, triggering an automatic 20 percent cut in benefits. Congress could redirect money from Social Security’s much bigger retirement program to shore up the disability program, as it did in 1994. But that would worsen the finances of the retirement program, which is facing its own long-term financial problems. By the time disability cases reach an administrative law judge, the claims have been rejected at least once and often twice by workers in state offices. House Oversight Committee chairman Darrell Issa, a California Republican, was incredulous that so many judges would rule that initial rejections were so often wrong. -See the full Boston Globe article...
High Court Says Children Over 21 Must Go to Back of Visa Line A divided Supreme Court ruled this month that most immigrant children who have become adults during their parents’ years-long wait to become legal permanent residents of the United States should go to the back of the line in their own wait for visas. In a 5-to-4 decision, the justices sided with the Obama administration in finding that immigration laws offer relief only to a tiny percentage of children who ‘‘age out’’ of the system when they turn 21. The majority — tens of thousands of individuals — no longer qualify for the status granted to minors. The case is unusual in that it pitted the administration against immigration reform advocates who said government officials were misreading a law intended to keep families together by preventing added delays for children seeking visas. Because approving families for green cards can take years, tens of thousands of immigrant children age out of the system each year, according to government estimates. Congress tried to fix the problem in 2002 when it passed the Child Status Protection Act. The law allows aged-out children to retain their child status longer or qualify for a valid adult category and keep their place in line. But appeals courts have split over whether the law applies to all children or only those in specific categories. The Obama administration argued that the law applied only to a narrow category of immigrants . Government attorneys said that applying the law too broadly would lead to too many young adults entering the country ahead of others waiting in line. -See the full Boston Globe article... Opioid Abuse: Patrick Airs $20m State Plan and 5 States to Jointly Combat Overdoses State Proposal Governor Deval Patrick unveiled plans this month to upgrade treatment for opioid addicts, expand insurance coverage, and coordinate with the other five New England governors to stem an epidemic that has claimed hundreds of lives in Massachusetts since last fall. Key elements of the $20 million plan, which could create hundreds of new treatment beds, target the needs of adolescents and young adults, who made up about 40 percent of clients treated in fiscal 2013 by the state’s Bureau of Substance Abuse Services. Among other recommendations, developed by a task force created in March, the state would provide four more residential treatment programs and five home-based programs to serve teenagers and young adults. Many of the additional programs proposed by Patrick would require legislative approval for funding, and the state Senate has put forward a parallel plan. Hard-hit regions and demographic groups are addressed in Patrick’s plan. In one example, a detox facility would be created in Franklin County, which has no such service now. Addicts and others struggling with substance abuse in that sparsely populated county, which borders Vermont, often forgo treatment rather than travel elsewhere for help. In other efforts to fill gaps in services, the task force recommended creating a family residential treatment program and two adult residential facilities that would give priority to Hispanic people and single adults with children. The recommendations also push for a mandatory level of treatment that private insurers should cover. To reach that goal, the Health Department, state Division of Insurance, and state Health Policy Commission will undertake a thorough review of current coverage. Patrick said he has heard “story after story” from patients whose private insurers have told them to look for coverage instead with MassHealth, the state’s insurance plan for low- and moderate-income residents. The plan would also create a central database, accessed through a toll-free number, that provides a real-time inventory of beds and other treatment resources. Many counselors complain that they call facilities over and over, often every day, only to be told that no beds are available or to call back. Another key recommendation, Bartlett said, is to develop state regulations that help reduce the diversion and misuse of prescription painkillers, often cited as a gateway to heroin addiction. -See the full Boston Globe article... Regional Collaboration Five New England governors agreed this month to work across state borders to address a surge in drug overdoses, promising to better monitor the prescription of opioid painkillers and to expand access to addiction treatment. Following private talks at Brandeis University, the governors said they would explore sharing prescription data on a broad scale, in part to curb “doctor shopping” by patients and small-time drug dealers who skirt prescription limits by visiting multiple physicians. The region’s chief executives, minus only Governor Paul LePage of Maine, said they would push for mandatory registration in the Prescription Monitoring Program, a growing, online database doctors can check for the prescription histories of individual patients. The governors pledged to forge agreements among state Medicaid programs to allow patients to cross borders for drug-abuse treatment. Under that plan, if one state does not have beds immediately available for treatment, an addict in desperate need of help could turn to other New England states. The governors agreed to form a working group composed of high-level state officials to build the framework for sharing prescription data and to make treatment more accessible. Its recommendations will be due at the end of September, Patrick said. Maine’s LePage is focusing on law enforcement instead of treatment to crack down on the opioid problem. -See the full Boston Globe article... State Job Training Programs Declining in Massachusetts State funding for workforce training has fallen over time, down 30 percent between FY 2001 and FY 2014 according to a new brief. MassBudget’s brief Investing in People: Jobs and Workforce Training in the Massachusetts State Budget reports that this reduction is driven largely by a $46 million cut to the Employment Services Program, which primarily funds employment and training services for recipients of temporary assistance (TAFDC). Since cutting taxes by over $3 billion between 1998 and 2002, our state has made deep cuts across the budget. This drop in revenues has meant that our state has been barely able to balance the budget even in good times. In times of economic crisis we are forced to make difficult decisions to cut programs and rely on reserves to fill some of the gaps. State spending on workforce training has not been immune to this trend. -Adapted from Jobs & Workforce Programs in the State Budget - two new resources, MassBudget, June 11, 2014 and Investing in People: Jobs and Workforce Training in the Massachusetts State Budget. Rivals Warn Partners’ Growth Will Raise Costs A coalition of Massachusetts health care providers that compete with Partners HealthCare on recently declared its opposition to a tentative pact allowing Partners to acquire at least three more hospitals, saying the expansion would have “profound and negative effects on the cost of health care” and possibly lead to the “extinction” of some hospitals. Leaders of the group — including executives from Tufts Medical Center, Beth Israel Deaconess Medical Center, Lahey Health, and Atrius Health — outlined their “grave concerns” about a deal struck between state Attorney General Martha Coakley and Partners, the state’s largest hospital and physicians network. “This agreement does not address the issue of costs and the disparity in payments” between Partners hospitals — including Harvard-affiliated Massachusetts General and Brigham and Women’s — and their rivals, said Tufts Medical Center president Michael Wagner. The opposition, in the form of letters to Coakley and a top deputy, marks the first time the competitors have publicly challenged the agreement in principle between Partners and the attorney general’s office. The agreement would let Partners complete takeovers of three hospitals, South Shore Hospital in Weymouth and two hospitals operated by Hallmark Health north of Boston, and add at least 550 doctors. It would also limit how much Partners can charge for medical services and restrict further growth for five to 10 years. The letters suggest the agreement, meant to help control health costs by restraining Partners’ market power, could have the opposite effect by locking in advantages Partners already holds. A longstanding gap between the prices Partners commands for medical care and what others can charge would be preserved or increased under the pact, the competing health providers said, even though the agreement places a cap on health care prices. The rivals also doubt the effectiveness of a provision — also meant to control costs — allowing health insurers to contract separately with Partners’ teaching hospitals and community hospitals. -See the full Boston Globe article... Opinion: DCF Cannot be Viewed in Isolation A new report from the Massachusetts Law Reform Institute is the latest in a series of overhauls proposed for the beleaguered Department of Children and Families DCF since the department’s immense shortcomings were laid bare in vivid, heartbreaking detail a few months ago. The institute report urges the state to think about DCF’s problems in that wider context, rather than focusing solely on how well social workers are funded and supervised. “It’s a call for systemic reform,” says attorney Susan Elsen, who wrote the report. “We need a multi-agency child welfare system.” If we are going to keep more kids safe, we must acknowledge that everything is connected. What happens in one corner of state government directly affects kids in another, who have nobody but the state to protect them. Over half of the families with very young children under DCF care have substance abuse issues, mental health issues, or domestic violence issues, according to the report. Many battle all three. If parents can’t find adequate shelter, mental health services, drug treatment, or jobs that sustain them, kids face greater risk. And so before the Legislature reduces funding for detox beds, or the state changes the emergency shelter rules, they should be required to run the numbers. How many kids will be made more vulnerable as a result? It might not be pretty, or cheap. But child impact statements would force us to confront something we’ve been dodging for decades: The onus of safeguarding children at risk cannot be DCF’s alone. Those kids often require more than any one agency can give them. They belong to all of us. -See the full Yvonne Abraham column in the Boston Globe...
Drug-Addicted Babies in Mass. at Triple National Rate New research shows that the number of babies born in Massachusetts with opiates in their system is more than triple the national rate. Hospital diagnoses data reported to the federal government and obtained by the Globe also show that the toll of opiate addiction is affecting babies not only in Massachusetts, but in New England as a whole, at far greater rates than the rest of the nation. “If you don’t know the scope of the problem, how can you begin address it?” said Dr. Elisha Wachman, a neonatologist at Boston Medical Center who specializes in treating these babies and is involved in an effort by 42 Massachusetts hospitals to determine the prevalence of drug-exposed babies and improve their care. Based on the hospitalization figures, Wachman and other researchers estimated that more than 1,300 Massachusetts babies — or about 17.5 per 1,000 hospital births— were born with narcotics in their system in 2013. Nationally, the figure is five babies out of every 1,000 births, based on hospitalization figures from 2012, the most recent available from the Federal Agency for Healthcare Research and Quality. Babies born addicted to drugs typically experience painful symptoms that can include difficult feeding and breathing, diarrhea, vomiting, and seizures that can last for weeks, even months. The long-term effects of the condition, known as neonatal abstinence syndrome, are unknown because few studies have looked at these children beyond the first years of life, when some cognitive or movement impairment could be detected. There are also no recent studies that compare the effectiveness of different treatments, leaving different hospitals to adopt different protocols, said Dr. Robert Sege, a pediatrician and medical director of the Child Protection Team at Boston Medical Center. At BMC, which has a prenatal clinic that specializes in the care of mothers struggling with substance abuse, about 150 babies born each year are exposed to prenatal opiates — the highest among Massachusetts hospitals. Infants there remain in the hospital, typically with their mothers, for an average of 19 days as doctors and nurses administer varying doses of morphine while assessing their withdrawal symptoms. At other hospitals in the country, infants are sent home sooner and are prescribed an oral methadone to be taken over two or three months, Sege said. “I don’t know which is right,” Sege said. There are also non-pharmalogical ways to treat these babies and keep them comfortable, Wachman said, such as tight swaddling, allowing babies to rest in a dark corner undisturbed for several hours at a time between feedings and medications, and encouraging skin-to-skin contact with their mothers as well as breast-feeding, if possible. “A lot of hospitals don’t have guidelines for these things, which should be standard in how we treat these babies,” Wachman said. -See the full Boston Globe article...
When a Stressful Hospital Stay Makes You Sick: "Post-Hospital Syndrome" It’s long been known that hospitals can be the source of illness — 1.7 million Americans develop hospital-acquired infections each year. But post-hospital syndrome is something different and more ominous. In a 2013 paper, Dr. Harlan Krumholz, a professor of medicine and public health at Yale School of Medicine, described a syndrome that emerges in the days and weeks after a hospital stay: “Physiologic systems are impaired, reserves are depleted, and the body cannot effectively avoid or mitigate health threats.” He called this period of vulnerability “post-hospital syndrome.” The syndrome was identified as a result of new Medicare rules that hold hospitals responsible for re-admissions within 30 days after discharge. When health systems began studying patients who returned to the hospital soon after discharge, two critical facts emerged. First, the problem is common and widespread, occurring after nearly one in five hospitalizations of patients on Medicare. Second, and even more surprising, the majority of cases represent an illness distinct from the initial hospitalization. Post-hospital syndrome is therefore not a relapse, it is a state of susceptibility that most often leads to a new affliction. Infections, for instance, which are known complications of a hospital stay, were just one small category of post-hospital illnesses tracked in a large study of Medicare admissions. Others included heart failure, gastrointestinal conditions, mental illness, nutrition-related problems, electrolyte imbalances and trauma (probably from falls and weakness). Last month in JAMA, Dr. Krumholz and Dr. Allan Detsky, a professor of health policy at the University of Toronto, for the first time described precisely how to fix post-hospital syndrome: fix the hospital “In many ways the hospital environment can be the opposite of healing,” Dr. Krumholz said. Beeping machines, frequent needle sticks, unpredictable waits to see the doctor, unappetizing food and sleep deprivation are among the barrage of stressors he cites. “The result is that hospitalized patients are often deconditioned, in pain, malnourished, stressed, with circadian disruptions,” he said. “And we ask why patients return to the hospital? Maybe it’s what we’ve done to them.” To help solve the problem, Drs. Detsky and Krumholz have proposed sweeping changes in hospital care. Their recommendations range from more cheerful décor and preserving dignity by having patients wear their own clothing, to reducing needles and procedures. They call out most hospitals for serving a “draconian unsavory diet” at a time when eating well is critical for healing. They also cite sleep deprivation caused by machine alarms, unnecessary wake-ups, and preventable room traffic. -See the full The New York Times blog entry...
Did FDA Antidepressant Suicide Warnings Backfire? Warnings from the US Food and Drug Administration (FDA) stating that the use of antidepressants among young people may increase the risk for suicidality may have backfired. The safety warnings were covered widely in the media and led to a decrease in antidepressant use by young people, but at the same time, there was an increase in suicide attempts, Christine Y. Lu, PhD, of the Department of Population Medicine, Harvard Medical School in Boston, Massachusetts, and colleagues found. "It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting," the researchers conclude in a report published online June 18 in BMJ. Between 2003 and 2004, the FDA issued several health advisories warning that children and adolescents taking antidepressants were at increased risk for suicidal thoughts and behavior. In October 2004, they required that a black box warning of this risk be added to labels of all antidepressant drugs. In May 2007, the FDA extended the warnings to include young adults. In analyzing healthcare claims data from 11 health plans in the US Mental Health Research Network, the researchers found that antidepressant use fell by 31.0% among adolescents, by 24.3% among young adults, and by 14.5% among adults after the warnings were issued. The researchers say that it is possible that the warnings and extensive media attention led to "unexpected and unintended population level reductions in treatment for depression and subsequent increases in suicide attempts among young people." "FDA advisories and boxed warnings can be crude and inadequate ways to communicate new and sometimes frightening scientific information to the public. Also, the information may be oversimplified and distorted when communicated in the media," they add. The researchers say greater efforts are needed to improve risk communications to the public and to health professionals. "Active surveillance should be considered to allow timely detection and prompt actions to reduce unintended consequences of strong warnings," they conclude. -See the full Medscape summary article...
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