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MGH Community News |
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MGH Community News |
| July 2014 | Volume 18 • Issue 7 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
New Mass Welfare Law
A new state law, An Act to foster economic independence, was signed into law this month. The law, now known as Chapter 158 of the Acts of 2014, makes changes to the Transitional Aid to Families with Dependent Children Program (TAFDC), and the Emergency Aid to the Elderly, Disabled, and Children Program (EAEDC), the state's cash assistance programs for the Commonwealth's lowest income residents. Both programs are administered by the Department of Transitional Assistance (DTA). Provisions Advocates View as Positive:
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The law also reduces the period for benefit extensions, changes the number of days in which a temporary absence from the state creates a presumption that residency has been abandoned, requires the calculation of the five-year benefit cap on the family rather than separately for each parent, and requires verification of work participation forms by a third party under the penalties of perjury. DTA would also be required to share information with federal, state and local law enforcement and the trial court about benefit recipients who are the subject of felony warrants, according to the bill summary. Thank you to Greater Boston Legal Services and Crittenton Women's Union for sharing the bulk of this analysis. Additional Sources and for More Information
Emergency Assistance (Family Shelter) Family Guide The Mass Law Reform Institute and Rosie’s Place have created a new Emergency Assistance (EA) Family Guide (in English and Spanish) to help families applying for EA family shelter. The guides are clearly and concisely written, include important tips and address the following questions:
The guides are available at: http://www.masslegalservices.org/content/emergency-assistance-application-guide-families and have been posted to the Staff Access section of our website. -Thanks to Liz Speakman for sharing this resource.
Boston Housing Authority New Intake Process and Business Hours In a letter dated June 16, 2014, the Boston Housing Authority (BHA) delineates some changes in their housing application process. The letter is excerpted below:
Clients who have questions about applying for any BHA housing program can see a staff member in the Housing Service Center on Mondays, Tuesdays and Wednesdays from 9:00 a.m. to 5:00 p.m. Current Section 8 participants who need assistance are welcome Monday through Friday between 9:00 a.m. and 5:00 p.m. -Thanks to Sandy McLaughlin for bringing this to our attention. Also see: http://www.bostonhousing.org/en/For-Applicants/How-Do-I-Apply-for-BHA-Housing.aspx Social Security and SSI Post-DOMA: Detailed Explanation The National Senior Citizen Law Center recently presented a webinar on Social Security and SSI since the overturn of a key provision of the Defense of Marriage Act (DOMA) just over a year ago. We reported briefly on Social Security and Medicare post-DOMA last month (Medicare, Social Security & the Overturn of DOMA - Where Do We Stand?, MGH Community News, June 2014). This webinar offered more detail specifically about Social Security and SSI, summarized below. Until last month many OASDI & SSI applications involving same sex relationships were on hold. SSA with the Department of Justice has developed policy for adjudicating most claims involving same sex relationships. The policy is contained in POMS GN 00210. Windsor Decision Benefits Some, Harms Others In general the Windsor decision that overturned key aspects of DOMA will have a beneficial impact on most of those applying for Social Security Old Age, Survivor and Disability Insurance (OASDI) benefits, often just called Social Security. It will generally not be helpful, and may be harmful, for those seeking Supplemental Security Income (SSI). Since SSI is a means-based program that considers a spouse’s income in determining eligibility and benefit levels, a newly recognize marriage may mean one is no longer eligible or is eligible at a lower benefit level. Social Security - OASDI The Social Security OASDI benefits that are dependent upon marriage are the Spousal Benefit, Widow’s (Widower’s) Benefit and the Lump Sum Death Benefit . Unfortunately, the new policy uses a “place of domicile” rule rather than a “place of celebration” rule to determine if a same-sex couple is married. If they were married in a state that recognizes same-sex marriage, but live in a state that does not, they are not considered married for the purposes of OASDI benefits. Registered domestic partnerships (RDP), civil unions (CU) and reciprocal beneficiary relationships (RBR) may qualify for these benefits if the state allows intestate (without a will) succession of personal property on same basis as for husband and wife. See state chart at POMS GN 00210.004 – see section D. The Spousal benefit allows a beneficiary to receive a monthly benefit equal to the greater of the benefit to which she is entitled on her earnings record or half of the spouse’s benefit. In other words if the spouse earned more than twice the beneficiary’s salary, it would benefit the beneficiary to receive the spousal benefit. The insured’s place of domicile at time of application determines same-sex marriage recognition. If one is already getting benefits and subsequently moves to a state that does not recognize same-sex marriage, benefits continue. However, one cannot just move temporarily to a marriage-recognition state for the purpose of getting benefits. The Widow (Widower’s) Benefit provides the surviving spouse the greater of the benefit on her own earnings record or the earnings record of her deceased spouse. The insured’s place of domicile at time of death determines same-sex marriage recognition (also used for Death Benefit). Benefits continue wherever the widow(er) resides. Remember that other eligibility criteria apply as well, such as the minimum length of the marriage. Remember also that divorced spouses also may also be eligible for the spousal benefit or the Widow (Widower’s) benefit. A small number of people who are receiving widow(er)’s benefits as a divorced spouse and subsequently entered into same sex marriage prior to age 60 (and are not disabled and at least age 50) could lose current benefits as result of new the relationship being recognized. Anyone eligible should apply as soon as possible as these benefits are awarded based on date of application. Each month of delay in filing could result in loss of a month of retroactive benefits. If denied, be sure to file a Request for Reconsideration within 60 days. Supplemental Security Income (SSI) Windsor provides no new benefits for people on SSI. If a marriage is recognized, the income and resources of both spouses will counted for eligibility purposes and amount of benefits. Therefore, relationship recognition is far more likely to cause loss of benefits rather than increase. So in applying for SSI, advocates, perversely, hope for marriage not to be recognized. SSI marriage recognition is determined by state of residence and then only if living together. Registered domestic partnerships (RDP), civil unions (CU) and reciprocal beneficiary relationships (RBR) are not marriage for SSI even though the person may be receiving an OASDI spousal or survivor benefit. For SSI eligibility, SSA looks at some opposite-sex couples who are not legally married as “holding out” as married, meaning they present themselves to the community as married. In those cases the income and resources of both are considered. SSA has said that they will NOT view same-sex couples as “holding out”. This means that they will consider only the applicant’s financial circumstances. One may be considered “married” for Social Security OASDI and not considered married for SSI, for example if one moved to a non-marriage recognition state after approved for benefits, or if legally married, but no longer living together. Unresolved SSI Issues NSCLC applauds SSA’s overall positive record on SSI. They note, however, that two serious problems remain:
-Adapted from and more information at: http://vimeo.com/101442887. FY 15 State Budget Social Service-Related Provisions Below are excerpts from MassBudget.org’s analysis of the fiscal year 2015 state budget. The fiscal year started July 1. Child Care The number of children on the wait list for income eligible childcare had been decreasing as a result of the $15 million appropriation in FY 2014, but has begun to rise again in recent months. The new wait list appropriation will provide a subsidy for some still waiting, but will not provide support to the majority of children and families on the waitlist. The Children’s Trust Fund’s Healthy Families Home Visiting Program receives $14.5 million, almost $4 million more than FY 2014 current spending. This program provides home visits for first-time parents under the age of 21. Providing home visits to first time parents of very young children has been shown to decrease the need for child welfare interventions later. Supportive Child Care for children in the care of the Department of Children and Families also received an increase of $2.7 million over FY 2014. Public Health/Substance Use Disorder Treatment The Legislature's budget includes:
Housing
The Legislature's budget also allows the Department of Housing and Community Development (DHCD) to spend up to $2.5 million to create a new, state-wide housing application process and waiting list. The budget also funds a pilot program in western Massachusetts to provide nutritious meals to families living in hotels and motels who often do not have access to cooking facilities. Human Services The Massachusetts Unaccompanied Homeless Youth Commission is level-funded at $150,000 This commission was introduced in the FY 2013 budget and is continuing to try and quantify need and determine how to best deliver services to homeless youth under the age of 24. Disability Services Head Injury Treatment Services through the Massachusetts Rehabilitation Commission (MRC) is increased $3.4 million (28.2 percent) to $15.7 million. Elder Services Elder Enhanced Home Care Services receives a $10.1 million increase over FY 2014 to $63.1 million. This increase will avoid wait lists for home care for the elderly allowing over 5,000 elderly to remain at home instead of living in a nursing home. Transitional Assistance The caseload for Transitional Assistance for Families with Dependent Children (TAFDC) dropped from 46,546 in December 2013 to 44,592 in May 2014. The decrease in caseloads has led to a decrease in the projected spending amount for FY 2014. However, instead of reducing funding, the Legislature could have increased the cash grant available for eligible families. The cash grant for these families has not changed in over a decade and has lost 25 percent of its buying power since FY 2001. For a more in depth analysis of the grants value, see TAFDC: Declines in Support for Low-Income Children and Families. Savings from caseload reductions could also have been used to:
The $40 rent allowance and the $150 children's clothing allowances are included in the FY 2015 budget, but the value of these allowances also decreases each year due to inflation. -See the full MassBudget.org budget monitor... First Deferred Action for Childhood Arrivals Cases to Expire In September; Renewal Instructions Released The U.S. Citizenship and Immigration Services (USCIS) has submitted to the Federal Register an updated form to allow individuals previously enrolled in the Deferred Action for Childhood Arrivals (DACA) program to renew their deferral for a period of two years. Effective immediately, USCIS will begin accepting renewal requests. The first DACA approvals will begin to expire in September 2014. To avoid a lapse in the period of deferral and employment authorization, individuals must file renewal requests before the expiration of their current period of DACA. DACA, Deferred Action for Childhood Arrivals, is a discretionary determination that allows those who qualify to remain in the United States and apply for employment authorization for a period of two years. Individuals who have not requested DACA previously, but meet the criteria established, may also request deferral for the first time. It is important to note that individuals who have not continuously resided in the United States since June 15, 2007, are ineligible for DACA. Individuals may request DACA renewal if they continue to meet the initial criteria and these additional guidelines:
To learn more about the renewal process or requesting initial consideration of DACA, visit www.uscis.gov/childhoodarrivals or call the USCIS National Customer Service Center at 1-800-375-5283. -Adapted from Border Crossings and State Roadblocks: MIRA BULLETIN, MIRA Coalition, Thursday, July 10, 2014. Long Waits for English Classes Statewide, only a fraction of adults looking to take English language classes are able to do so each year, with demand far outweighing supply. A recent study by the quasi-public Commonwealth Corporation found that just 5 percent of approximately 237,000 immigrants with limited English language skills in Greater Boston were being served by the various programs supported by the state’s Department of Elementary and Secondary Education. For the most part, community adult education programs funded by the state education department are offered free of charge and therefore attract the largest number of applicants, resulting in waiting lists that can be as long as two years. Even fee-based classes, which can be financially inaccessible for many immigrants and have fewer participants, have waiting lists that can run up to a year, said Eva Milona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition. As of last December, the number of people waiting to enroll in adult basic education classes statewide was 18,000, and of those, more than 13,000 were waiting specifically for English language classes, she said. Approximately 25,000 people enroll annually in adult basic education classes. The waiting list has been stuck at this level for several years, according to Milona. State support for adult basic education services, currently at $30.2 million, has been level-funded for several years, leaving agencies to compete for private dollars and grants in order to expand services. Programs in gateway cities like Brockton and Quincy will often be disqualified from private funds because they’re not in Boston, according to local organizers involved in fund-raising. Tired of seeing disappointment and despair in people’s faces when told they would have to wait a year or two, or maybe three, for a class, Ruth O’Brien-Denly, a career and education advisor at Training Resources of America Inc. in Brockton , decided she’d had enough. The agency has a waiting list of 308 people for its free English courses. “It got to the point where I couldn’t look at people and say that,” O’Brien-Denly said. “It’s very disheartening when they look at you and cry. It happens a lot. . . . You’re dashing their hopes.” In February 2009, along with a group of educators, O’Brien-Denly launched Connecting Through Community, a wholly volunteer effort offering free English classes every Saturday morning at the Brockton Public Library. It didn’t take long for word of mouth to spread, and today they teach about 70 to 80 people a year O’Brien-Denly said. Organizers urge anyone looking to enroll in an English class not to be discouraged by the long waiting lists, and to sign up with several agencies to improve their chances of getting in sooner. The state also runs an adult literacy hotline, 1-800-447-8844, through which people can find local courses, said Barbora Hazukova of Training Resources of America in Brockton. -See the full Boston Globe article... How a Parent’s Health-Care Bills Could Hurt You: How to Sign Contracts as Power of Attorney Moving a parent into a care facility is often a wrenching decision for families. Despite the emotions involved, it’s important to remain clear-eyed when it comes to signing the contract. Otherwise, adult children could find themselves on the hook for much more than they bargained for. Many older people moving into a nursing home or retirement community are experiencing cognitive decline. So a trusted person—usually an adult child—will sign the entrance contract on their behalf as power of attorney. Yet elder law attorneys report a widespread misunderstanding of what it means to sign a contract for a cognitively impaired loved one, whether that person is entering a care facility or simply signing off on a cellphone agreement. If you sign your name in lieu of your parent’s on a contract without adding any additional language, then you may be viewed as acting as a guarantor who is personally responsible for the payments. The best way to separate your responsibility as power of attorney from any personal financial obligation is to sign your parent’s name as the responsible party on the contract, and after that write, “by [your name] as power of attorney,” followed by the date, said Bradley J. Frigon, an elder law attorney in Denver and president of the National Academy of Elder Law Attorneys. -See the full MarketWatch.com article...
DCF Hires 230 New Workers, but Caseloads Remain High The Department of Children and Families, after months of controversy and the deaths of several children on its watch, has hired more than 230 new employees, but the agency has yet to cut into the high caseloads, frustrating many child-care workers. Erin Deveney, whom Governor Deval Patrick selected to lead the struggling agency in April, described the new hiring to state lawmakers this month, but noted that DCF also lost employees because of turnover. Factoring in retirements and resignations, she said, the department had 143 more social workers at the end of June than it did at the beginning of the year. Despite the gains in hiring, however, she told members of two House committees that she is unsure when the agency will reach one of its chief goals: a steady rate of 15 cases per worker. In May, she said, the state average was about 20 cases per worker, similar to what it was before the first of the year. Peter MacKinnon, president of the union chapter that represents child welfare workers in the state, said the problem is the surge of new employees has not matched the rise in the number of cases they face. MacKinnon told lawmakers that the numbers of cases have increased because local managers who provide initial screenings for the department “remain fearful” that they could make a wrong decision on reports of neglect or abuse, as DCF has come under greater scrutiny. As a result, they take on more reports for more full investigations. Deveney said the agency is changing a number of policies including a revised training model, peer support for social workers dealing with trauma, and a requirement that staffers meet face to face whenever they transfer a case. One move outlined by Deveney appears connected to another controversy that dogged the agency recently. The agency plans to hire a medical director, following a legal battle surrounding Justina Pelletier, a Connecticut teenager who spent months in state custody after doctors accused her parents of medical child abuse. Most of the improvements to the agency are covered by the Legislature’s new budget, which sets aside $827 million for DCF, a boost of $48 million over the agency’s funding in the previous year. -See the full Boston Globe article... Student Debt ‘Help’ is Often Abusive, Officials Say Debt settlement companies, which offer to help borrowers lower monthly loan payments for a hefty upfront fee, have long been fraught with problems. But federal and state regulators are spotting new instances of abuse as the companies shift from their traditional targets — credit card and mortgage debt — to zero in on student loans. The companies are coming under fire for potentially questionable tactics. Illinois is expected to become the first state to bring legal action against debt settlement companies based on student loan practices, contending in two lawsuits that Broadsword Student Advantage and First American Tax Defense duped vulnerable borrowers into paying for help that never arrived. In her suit against the companies and their operators, Lisa Madigan, the Illinois attorney general, contends the businesses lured borrowers into paying hundreds of dollars upfront, and in the case of Broadsword, $49.99 a month after that, according to copies of the lawsuits reviewed by The New York Times. The companies often misled customers about those fees, according to the suits, and in some instances feigned affiliation with federal relief programs. In a particularly cruel twist, Madigan said, the companies sometimes charged customers for debt assistance that they could have received free from the Education Department. As the industry has ballooned, so too have the complaints of misleading or outright abusive tactics. In 2013, for example, the number of complaints about the tactics reached 204,644, up about 10 percent from two years earlier. The Federal Trade Commission has sued several of what it calls bogus credit-related services that charged distressed borrowers hundreds or thousands of dollars, sometimes without their permission. -See the full Boston Globe article... Walsh Announces Plan to Aid Alzheimer’s Victims & Their Families Boston Mayor Martin J. Walsh this month announced an Alzheimer’s initiative that will make Boston the first major city to join the Alzheimer’s Workplace Alliance. The national group has nearly 2,000 companies and organizations that support employees with information on Alzheimer’s disease. Through this membership, up to 17,000 city employees, from police to public housing workers, will be trained in the particular needs of people with dementia and how best to care for the estimated 10,000 Bostonians suffering from Alzheimer’s, Walsh said. The alliance will not only help those with Alzheimer’s, but the estimated 30,000 family members in the city caring for those with the disease. “Too many caregivers try to do this alone, and we always say you cannot do Alzheimer’s disease alone,” said James Wessler, president of the Alzheimer’s Association of Massachusetts and New Hampshire. “Alzheimer’s can literally overwhelm a family.” The number of people with Alzheimer’s nationwide is expected to grow 25 percent from now until 2025, as the baby boom generation ages into their 70s, Wessler said. By 2050, the number of those suffering from the disease will grow threefold. “If we want to talk about the quality of life in Boston, we have to reach out to these folks,” Walsh said. “We have to help them find the answers that they need, so they can address and deal with what’s going on in their family.” -See the full Boston Globe article...
Subsidized Hubway Memberships and Free or Low-Cost Bike Repairs Subsidized Hubway Memberships Together with the Boston Public Health Commission, New Balance Hubway offers a subsidized Hubway annual membership for $5, which includes a free helmet. They are distributing these memberships to low income Boston residents and to community groups that serve these residents. For less than the price of three rides on the T one can have transportation for 3 seasons. The Hubway is a bicycle-sharing option that allows you to borrow a bike from one place and return it to another. As a member, you can access a bike from any station across Boston and beyond. See this map for station locations. Members use bikes for many reasons including to run errands, commute or even to get to a medical appointment. The closest Hubway stations to Mass General are at Cambridge Street and Joy Street and also at The TD Bank Garden. Eligibility You qualify for a subsidized membership if you are a resident of Boston who is at least 16 or older (note the program flyers have not been updated and still say 17) and meet one of the following criteria:
Please call (617) 918‑4343 and we’ll help you determine if you qualify for a subsidized membership. Cost
If you qualify for the subsidy, your annual membership cost will be $5, which includes a free helmet. Additional costs beyond your $5 membership are possible. For subsidized members, the first hour* of every bicycle trip is free, but there are usage charges after that. See our Hubway page for all the details. To Apply (Individuals): If you are interested in receiving a subsidized membership, please call (617) 918‑4343 to confirm your eligibility and get your subsidized membership code and free helmet today! If you need support in a language other than English, please e-mail najah.shakir@cityofboston.gov.
Program flyers in multiple languages are available: English, Spanish, Portuguese, Chinese, Vietnamese, Haitian Creole -Thanks to Sandy McLaughlin for sharing this resource. Free or Low-Cost Bike Repairs: Bike to Market Own your own bike? Bike to Market is an initiative to provide free or low-cost bike repairs in low-income neighborhoods where there are no local bike shops. The program is delivered by the Boston Cyclists Union as a way to serve the community, get to know the neighborhoods, and introduce their mission across the city. In 2013, more than 150 Boston Cyclist Union volunteers repaired 816 bikes at Farmer’s Markets in Dorchester, East Boston, Mattapan, Mission Hill, Roxbury, Roslindale, and South Boston. 2014: Free Bike Repairs All Over Boston! Does your bike need some help? Find low or no cost bike repairs and tune ups at a location near you – and learn to do some of the repairs yourself! Some locations will also sell low cost locks and helmets. -More at: http://www.bostonbikes.org/programs/bike-to-market/ New Toolkit Aims to Prevent Family Separation The Women's Refugee Commission recently released Detained or Deported: What About My Children?, a new toolkit that aims to assist parents caught up in the deportation system protect and maintain their parental rights and make well-informed decisions regarding the care and welfare of their children. The toolkit is available in both English and Spanish and can be viewed as a printed document or in an online, interactive format in either language. -From Border Crossings and State Roadblocks: MIRA BULLETIN, Thursday, July 10, 2014.
MassHealth Denture Coverage to be Restored in May 2015 The fiscal year 2015 state budget approved this month by the legislature and signed by the Governor maintains MassHealth adult dental coverage of fillings for all teeth and restores coverage for dentures by May 15, 2015. Back in 2010, benefits in the MassHealth adult dental program were significantly cut. Between now and the implementation of denture coverage, the only oral health services covered are cleanings, extractions, and fillings. Fillings were restored in two stages - first the front teeth in 2013, and for all teeth this year. While denture coverage is a significant improvement and the next logical next step in restoring full benefits, there still are some services not covered for most adults. Services that remain uncovered include root canals, deep scaling, crowns, and surgical procedures related to dentures.
MassHealth Reminder: Will MassHealth Take My House? Before Medicaid (MassHealth in Massachusetts) begins to pay for nursing home care, people must first qualify which generally means they have to spend down their assets to a very low level, $2,000 in Massachusetts. That money goes to the facility to pay for care, not into the state’s coffers. There are exceptions to this spend-down requirement including allowances for a healthy spouse who is living in the community and for children who are disabled. With respect to the house, unless a spouse or dependent child is living there, MassHealth will put a lien on the property. If the house is sold during the beneficiary's life, MassHealth must be reimbursed for the cost of care paid up until that point. If the house is not sold, then MassHealth will also have a claim against the beneficiary's estate when she passes away. This is often referred to as "estate recovery." However, this claim will only apply if the house is in her probate estate. If, instead, the house passes outside of probate through joint ownership, MassHealth will not be able to recover its costs. In those cases that MassHealth does recover its costs, the amount claimed is often less than anticipated. Here's an example. Let's assume that a house has a fair market value of $500,000 and the nursing home is charging $12,000 a month. Let's also assume that the senior receives $2,000 a month in Social Security benefits. In that case, if he sells the house and pays privately for his care, he will run out of money in about four years. If we assume that he lives for three years in the nursing home, spending $435,000 for his care, his estate will still have about $140,000 remaining. Here's the calculation:
$500,000 House proceeds In contrast, if our fictional senior kept the house, he could receive MassHealth immediately. He would save money because MassHealth pays nursing homes significantly less than their private pay rate. For our purposes, we will assume that MassHealth's rate is $8,000 a month. The senior would still contribute his Social Security to his cost of care, reducing MassHealth's cost, and could also rent out the house, earning more income to contribute further to his cost of care. For our purposes, let's assume that the house earns $2,000 a month after costs of maintaining the property. Here's how the calculations would work in this scenario:
$288,000 MassHealth Rate for Nursing Home for 3 Years Then, if the house sells for $500,000 after the MassHealth beneficiary's death, it will be paid its $144,000 at closing and the remaining $356,000 will pass to the senior's heirs, $212,000 more than would have been the case if they had not kept the house. (In some cases, seniors who have some remaining savings in addition to the house can save a bit more by keeping their home and using a pooled disability trust.) -See the full article on the Margolis & Bloom blog... Medicare Reminder: Durable Medical Equipment Supplier's Set-Up and Delivery Obligations The following guidelines, were gathered from the Centers for Medicare and Medicaid Services (CMS) instruction manuals for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers, and from the regulations implementing the DMEPOS competitive bidding program. They aim to help beneficiaries understand a supplier's delivery and set-up responsibilities. 1. General Set-Up and Delivery Requirements of DMEPOS Suppliers: According to CMS, a supplier of DMEPOS equipment is generally responsible for delivering and assembling all equipment items according to a timeframe that has been agreed upon by the Medicare beneficiary and/or their supplier, caregiver, and prescribing physician. If the supplier is not able to deliver and set-up the equipment, it may coordinate the set-up with another supplier. The supplier must provide the beneficiary with "all equipment and item(s) that are necessary to operate the equipment or item(s) and is to perform any adjustments as applicable." With the exception of orthotics and prosthetics, the supplier is also responsible for providing and arranging for replacement equipment while the original equipment is being repaired. 2. General Follow-Up Procedures: CMS states that "[T]he supplier shall provide follow-up services to the beneficiary and/or caregiver(s), consistent with the type(s) of equipment, item(s), and service(s) provided, and recommendations from the prescribing physician or health care team member(s)." 3. Products with No Set-Up and Delivery Requirements:
Although no set up is required for prosthetic and orthotic devices, the supplier is still obligated to provide the beneficiary or their caregiver with appropriate training and/or instructions. This consists of telling the beneficiary: how to use, clean and adjust the device; how to inspect the skin for any adverse reactions to the device such as breakdown or irritation; how to report problems with the device and schedule any necessary follow-up appointments; and how to create an appropriate schedule for wearing the device. Finally, the supplier must provide tools necessary for the maintenance of the device, such as cleaning tools. (More information in the full article.)
-See the full MedicareAdvocacy.org article, including more product specific DMEPOS set-up and delivery requirements.
More Windsor Guidance from CMS on Same Sex Spouses and Medicaid One-year after the Supreme Court’s landmark decision in United States v. Windsor, the Centers for Medicare and Medicaid Services (CMS) continues to release guidance on same-sex marriages and Medicare and Medicaid. CMS recently issued a letter to state Medicaid Directors with guidance on the implication of the decision for non-MAGI Medicaid populations (aged, blind or disabled or applying for long term care). The guidance gives states the discretion to apply either the IRS’ marriage recognition policy, which recognizes any marriage that is valid in the jurisdiction of celebration, or the state’s own marriage recognition law when determining whether a couple is lawfully married for purposes of Medicaid eligibility. States will be revising their Medicaid policies in light of the CMS guidance. Note that marriage recognition may benefit, but more likely harm, one’s eligibility for Medicaid. Special Medicaid Guidance for Those Who Qualify for SSI
The guidance also discusses specific policy for individuals whose Medicaid eligibility is linked to their
Civil Unions and Domestic Partnerships Timing More Information -Adapted from and for more information see: http://www.nsclc.org/wp-content/uploads/2014/07/CMS-Medicaid-Alert-on-Windsor-guidance.pdf
New Mass Healthcare Website Passes Key Test A new software system for the state’s health insurance website passed its first key test this month, and a final decision on whether Massachusetts will run its own site or join the federal exchange will be made in early August, a top state official said. Maydad Cohen, special adviser to the governor, said in an interview with the Globe that the new software by hCentive performed “with flying colors” in a Washington, D.C., demonstration, raising hopes that Massachusetts can keep a state-based exchange and recover from the failure of the original software. In the spring, the Massachusetts Health Connector abandoned that software, made by CGI, and adopted a “dual track” approach -- working on a new system while simultaneously preparing to join the federal exchange, healthcare.gov. Now, a time has been set to choose a single path, Cohen said. In a meeting Monday with Marilyn Tavenner, administrator of the US Centers for Medicare & Medicaid Services, officials demonstrated that software by the Virginia technology company hCentive can link to the federal “data hub,” the repository of Social Security and Internal Revenue Service data -- a connection essential for verifying identities and income. The next stage of the hCentive product will be completed by July 30. If it passes another test in the first days of August, the state will stop its preparations to join the federal website and focus on completing hCentive’s system in time for the start of open enrollment on Nov. 15. If it fails the August test, the state will join the federal exchange for next year but continue to try to develop its own system for 2016. Cohen also said that the hCentive program will be able to share information with MassHealth, the state’s Medicaid program, in a way that will enable enrollees to apply through the Connector, determine eligibility, and enroll in a “single-front-door” process. As a result, people found eligible for Medicaid, instead of the subsidized private plans sold by the Connector, won’t have to go through another enrollment process. -See the full Boston Globe article... Split Decisions on Federally Facilitated Health Insurance Marketplace Subsidies, but No Change for Now The D.C. Circuit Court of Appeals ruled this month on Halbig v. Burwell, holding that the Affordable Care Act does not authorize federally facilitated marketplaces to make financial assistance available to low-and moderate- income consumers to help them purchase coverage. If upheld, this ruling would undermine a key provision of the ACA and millions of consumers' ability to afford health insurance. During the last open enrollment period, 85 percent of enrollees were eligible for subsidies, including a large percent of those in communities of color. However, Families USA believes this decision is unlikely to be upheld, as it will likely be re-heard and overturned by the entire Circuit Court, and the King v. Burwell decision just released by the Fourth Circuit Court of Appeals held the opposite. For now, it is important that consumers understand that their financial assistance remains unaffected. -From Health Equity Connection 7-24-14, e-mail correspondence, Sinsi Hernandez-Cancio, Families USA.
NASW Seeks Public Comment on Draft Standards for Social Workers in Health Care Settings
NASW has updated its 2005 Standards for Social Work Practice in Health Care Settings. The draft of the new standards is now available for public comment. Feedback from the health care social work community is essential to ensure that the standards are Note: the public comment period ends at 11pm Eastern Daylight Time on August 15, 2014. Review the document and submit your comments.
Judge OKs Delay of Hearing on Partners-South Shore Hospital Deal Weeks after urging a judge to act quickly on a deal to allow Partners HealthCare to acquire South Shore Hospital in Weymouth, Attorney General Martha Coakley’s office got a judge to put the brakes on the process. Suffolk Superior Court Judge Janet Sanders this month granted a motion from Coakley’s office to delay a hearing on the merger deal from Aug. 5 to Sept. 29. Sanders also extended the deadline for the public to submit comments on the controversial deal to allow the health care giant to expand onto the South Shore from July 21 to Sept. 15, though Coakley’s office suggested the earlier cutoff remain in place. In its motion, Coakley’s office said it needed the additional time to potentially renegotiate parts of its deal concerning Partners’ bid to also acquire Hallmark Health’s two hospitals north of Boston based on a report due out from the state’s Health Policy Commission on Sept. 3. Neither South Shore Hospital nor Partners opposed the delay. The deal would allow Partners to acquire the three hospitals, but would make them all subject to caps on price growth and curtail Partners’ further expansion in eastern Massachusetts for the next decade. But critics say the deal would only solidify Partners’ dominance in the market. The proposed South Shore Hospital merger has won significant local support, including endorsements from the mayors of Weymouth and Braintree and business and labor leaders.
But Coakley has come under fire from a coalition of Partners’ competitors and her Democratic rivals in the race for governor for hammering out the deal behind closed doors. Critics of the deal had asked that Coakley hold off on filing it in court until the Health Policy Commission had finished its report on Hallmark. -See the full Patriot Ledger article... Florida Pilots New Medicaid Model to Better Coordinate Physical and Mental Health Care Seeking to improve care and lower costs, Florida this month became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression or bipolar illness. The plan -- offered by Avon, Conn.-based Magellan Complete Care -- is part of a wave of state experimentation to coordinate physical and mental health care for those enrolled in Medicaid. Mental illness is a big driver of Medicaid costs. It is twice as prevalent among beneficiaries of the public insurance program for the poor as it is among the general population. Studies show that enrollees with mental illness, who also have chronic physical conditions, account for a large share of Medicaid spending. Yet many Medicaid programs, including Florida’s, have traditionally contracted with separate companies to provide coverage for mental health services, making coordination more difficult. Traditional health plans sometimes fail to authorize sufficient outpatient treatment and rehabilitation services, so people end up needing to be hospitalized, advocates say. And patients with severe mental illness often have more difficulty dealing with other problems such as obesity and diabetes. “We don’t want to have a situation where your brain is in one HMO, your teeth are in a second HMO and your eyes are in a third HMO,” said Florida Medicaid Director Justin Senior. “Your whole head should be in the same organization and that is why we have done this reorganization.” Magellan’s model centers on a care coordination team made up of nurses, doctors and other specialists who will work with members and their families to achieve health goals. Magellan will also provide each member with a personal health guide who will help schedule appointments, arrange transportation to providers and help them follow treatment plans. The state is requiring Magellan to have a care plan and peer support group for each patient. The state has budgeted cost savings from the mental health plan, in part because it is paying Magellan 5 percent less per member, per month than it would cost to treat them if they were not in a managed care plan. Magellan hopes to profit by helping patients avoid hospital admissions and other expensive care. Medicaid health plans are paid higher rates for enrolling people with mental illness so they don’t have a disincentive to sign them up.
The Affordable Care Act, which is adding millions of people to Medicaid nationwide this year, has put more pressure on states to improve mental health care services. Such services are one of 10 categories of required “essential health benefits” under the law. The law also provides money to help states design programs to coordinate care.
-Adapted from: Florida Shifts Medicaid Mental Health Strategy. Medscape. Jul 08, 2014. Provided by Kaiser Health News.
MGH to Screen All Patients for Substance Abuse Massachusetts General Hospital will begin questioning all inpatients and patients in the emergency department about their use of alcohol and illegal drugs beginning this fall, whether they are checking in for knee surgery or visiting the emergency department with the flu. How often have you had six or more drinks on one occasion, nurses will ask, or used an illegal drug in the past year? If the battery of four questions recommended by the National Institutes of Health reveals a possible addiction, doctors can summon a new special team to conduct a “bedside intervention” and, if needed, arrange treatment. The mandatory screening program is part of a broad plan to improve addiction treatment at the Boston teaching hospital and its community health centers and is an example of an expanding national and statewide effort to reach substance abusers earlier and in mainstream medical settings. Nearly one-quarter of patients in the hospital for routine medical problems have active substance abuse disorders, according to national data — and that was before the recent epidemic of opioid abuse and overdoses in Massachusetts and other states. Dr. Sarah Wakeman, medical director for substance use disorders at Mass. General’s Center for Community Health Improvement, called being in the hospital “a reachable moment,’’ when social workers and psychiatrists can bring initial treatment right to a patient’s bedside. “We make it incredibly hard for people to access care for addiction,’’ she said. “Part of our goal is shifting the culture.’’ Many medical centers are adopting universal screening in their emergency departments, along with follow-up care — an approach pioneered by Boston Medical Center 20 years ago. Beth Israel Deaconess Medical Center in Boston began screening all emergency room patients for drinking and illegal drug use in January, while Brigham and Women’s Hospital, also in Boston, and Lahey Clinic’s Addison Gilbert Hospital in Gloucester adopted similar programs in the last several years. The American College of Surgeons has required hospitals to ask all trauma patients about their alcohol use since 2006 and will add screening for use of illegal drugs in July 2015. As the Affordable Care Act pushes hospitals and physicians to better coordinate care and lower costs, they are realizing that tackling substance abuse in traditional medical settings can further both these goals. Mass. General recently studied 2,583 patients with identified substance abuse disorders who were in the hospital for various medical problems — some related to addiction — and found they had longer stays and higher readmission rates than other patients. The cost of their care averaged nearly $10,000 per admission, 40 to 50 percent higher than the cost of treating patients with other chronic conditions such as congestive heart failure and pneumonia. As part of a 10-year strategic plan, Mass. General plans to spend at least $1.4 million a year on a new addiction screening and treatment program. It was prompted in part by a 2012 study of health needs in Chelsea, Charlestown, and Revere, which identified substance abuse as the number one concern. Mass. General will hire five “recovery coaches” — former substance abusers who are certified by the state — to work at the hospital and in the three community health centers. Coaches will accompany people needing longer-term care to Alcoholics Anonymous meetings and encourage them to stick to treatment plans. The hospital also plans to phase in screening for outpatients and establish an addiction discharge clinic to provide temporary treatment for patients who do not have immediate access to a primary care provider or therapist. -See the full Boston Globe article...
Big Rewards in Caring for Dementia Caregivers A brief psychological support program for family members who care for individuals with dementia dramatically reduces caregiver depression and anxiety, improves quality of life, and is cost-effective, new research shows. Two-year results from a randomized clinical trial conducted by investigators at University College London in the United Kingdom showed that caregivers who received treatment as usual were 7 times more likely to experience depression and anxiety compared with those who received the Strategies for Relatives (START) program, a brief, 8-session, manual-based coping strategy intervention. Twenty months after the study ended, individuals in the intervention group were "much, much less likely to be depressed than those in the nonintervention group. This was a massive, massive difference," said principal investigator Gill Livingston, MBChB, MD, FRCPsych. In fact, she noted that the results are so encouraging that the program is now being rolled out across England. Dr. Livingston presented the findings at a press briefing held at the Alzheimer's Association International Conference (AAIC) 2014. -See the full Medscape summary article... Better Diabetes Self-Management With Cognitive Therapy We know that diabetic control of patients who are depressed and have diabetes is improved if their depression is treated. Now a team of investigators from Massachusetts General Hospital have performed a randomized controlled trial to test cognitive-behavioral therapy (CBT) for adherence and depression in 87 adults with unipolar depression and uncontrolled type 2 diabetes. The control patients received treatment as usual, including medication adherence, self-monitoring of blood glucose, and lifestyle counseling, whereas those assigned to the intervention arm also received 9-11 sessions of CBT focused on adherence and depression. Analyses of 4-, 8-, and 12-month follow-up time points indicated that the intervention group maintained 24% higher medication adherence, 17% greater adherence to self-monitoring of blood glucose, and lower A1c values, with both groups being less depressed. The researchers concluded that CBT has enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression. -Excerpted from and for more information: http://www.medscape.com/viewarticle/826890 Achievement of Developmental Milestones in Young Adults With Pediatric Chronic Illness - A Meta-analysis Abstract
-See the full Medscape summary article...
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