Highlights

• MassHealth Erroneously Cuts Some SSDI Recipients
• SNAP Erroneously Cutting Some
• Durable POA Considerations
• Safe House for Trafficking Victims
• MassHealth Recertifications
• Medicare Hospice Coverage

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues
• Of Clinical Interest

Questions, comments about the newsletter? Contact Ellen Forman, x6-5807.

MassHealth Denture Coverage Restored

For the first time in 5 years, as of May 15, 2015, MassHealth is once again covering dentures for adults age 21 and over. MassHealth will also now pay for certain prosthodontic services (full and partial dentures, including repairs). 

MassHealth cut dental services for most adult patients on July 1, 2010. There have been a couple of previous incremental restorations, the result of the tireless work of advocacy groups. As of 3/1/14 MassHealth resumed coverage of diagnostic and preventive services (such as checkups, cleanings, and x-rays), extractions, emergency treatment, and all dental fillings for adults (a prior partial restoration only covered fillings for front teeth).

Still not covered for most adults: root canals, deep scaling, crowns, and surgical procedures related to dentures with the exception of members with undue medical risk or with one or more of the medical conditions listed in 130 CMR 420.425(C)(2): hemophilia, history of radiation therapy, acquired or congenital immune disorder, severe physical disabilities such as quadriplegia, profound mental retardation and profound mental illness. Other serious conditions may qualify. Prior authorization is required.

Populations who retain full coverage: Children and Adults with intellectual disabilities who are served by the Dept. of Developmental Services. Seniors who are on Senior Care Options plans (SCO's) and dual-eligibles enrolled in OneCare are also covered for all appropriate dental services.

Read the full provider transmittal letter DEN-93 here: http://www.mass.gov/eohhs/docs/masshealth/transletters-2015/den-93.pdf

- Adapted from MassHealth Renewals & Dentures, health-announce@masslawlists.org, on behalf of Vicky Pulos, Mass Law Reform Institute, May 15, 2015.

Some SSDI Recipients Cut from MassHealth in Error Due to Cost of Living Increase

Some Social Security Disability Insurance (SSDI) recipients erroneously lost their MassHealth Standard benefits in March based on the SSDI 2015 cost of living increase. MassHealth is working to identify the people affected. Meanwhile, MassHealth can correct individual cases brought to their attention.  

Most people on SSDI will have to renew their eligibility for MassHealth later in 2015 under rules that count income a new way. The rules include a deduction equal to 5% of the poverty level or $50 a month for a household of one; $67 a month for two. MassHealth did an automatic redetermination for SSDI recipients in March based on their Jan. 2015 SSDI COLA but did not apply the new rules or the $50 per month (5% FPL) deduction. This is why some of these people were incorrectly cut off.

Persons likely to have been cut from MassHealth Standard in error:

• under 65 with a disability and receiving SSDI,
• on MassHealth Standard in February 2015,
• was notified in March 2015 that their income is now too high for MassHealth Standard & their MassHealth will end,
• monthly income in March 2015 is $1355 or less for a household of one; $1833 for a household of two (for larger households, income must not exceed 138% federal poverty level  --see MLRI income tables on masslegalservices.org).

People with disabilities & SSDI who are NOT affected are those who:

• are also receiving SSI,
• had to satisfy an asset test to get MassHealth for long term care,  home & community based waiver services or as a Disabled Adult Child (DAC);
• are age 65 or older,
• have a current monthly income of more than 138% of poverty for their household size (e.g. over-income for MassHealth Standard due to more changes than just the SSDI COLA).

What To Do

If your  patient has already reapplied in new HIX and is now on CarePlus, call MassHealth & ask them to  upgrade  your client to MassHealth Standard based on receipt of SSDI. This should be a one phone call fix. Call the MEC & follow prompts to report a change. Your client will need to be with you, on a three-way call, or written permission for MassHealth to talk to you will need to be on file. 

If your client/patient has not reapplied in new HIX or (reapplied but has a gap in coverage), obtain whatever permission you may need from your patient and send secure email with details to Nancy Lorenz at GBLS at nlorenz@gbls.org or Kate Bicego at HCFA at kbicego@hcfama.org. They will send a secure email to MassHealth to have these cases reviewed. Include in your secure email: client's name, date of birth, and MassHealth ID No. or SSN, date of termination notice (if available), and amount of SSDI, other household income, & household size.

-Adapted from Alert for SSDI recipients (under 65) who lost MassHealth in March based on income, health-announce@masslawlists.org, on behalf of Vicky Pulos, Mass Law Reform Institute, May 12, 2015.

The Baker administration said it will have to spend millions of dollars to repair a food stamp computer system that has continued to unfairly deny thousands of elderly, disabled, and working poor their food stamp benefits — a situation officials called horrible.

The $35 million system was rolled out last year, and the Patrick administration gave assurances that it was running properly in late December, after early trouble with processing food stamps arose. But problems have persisted, as the system mistakenly closed thousands of food stamp accounts, leaving people at grocery stores with baskets of food they were unable to pay for when their cards were rejected. (See Fraud Detection System Erroneously Cuts Thousands from Food Stamps – Advocates Create Tips Packet, MGH Community News, March 2015.)

The issue has gotten little public attention in recent months, but those in state government have been well aware of it.

Administration officials said the problems appear to be complex and won’t be solved quickly. In an April 27 letter to the US Department of Agriculture, state Health and Human Services secretary Marylou Sudders laid out a plan that includes hiring 73 new caseworkers and a consultant to review the system, and creating an ombudsman’s office to field complaints. The state will also upgrade the agency’s outdated phone system and pay overtime to workers coming in on Saturdays to help fix problems, including review of a backlog of 100,000 documents. The cost of these measures: about $4 million.

Jeff McCue, commissioner of the Department of Transitional Assistance, who was appointed by Governor Charlie Baker last month, said the system was not adequately tested or vetted before it was rolled out publicly on Oct. 27.

Food stamp recipients are the latest group affected by chronic breakdowns in newly automated systems created to streamline and improve government services. In 2013, the administration of Governor Deval Patrick disastrously launched an online system to manage unemployment benefits that resulted in thousands of problems for jobless workers whose benefits were delayed or erroneously cut.

That was followed by the 2013 software failure of the Massachusetts Health Connector, which left people unable to access health coverage.

The problems with the food stamp program began last year when the state decided to upgrade the way food stamps are managed under pressure from the Department of Agriculture. The USDA oversees the food stamp program, known as the Supplemental Nutrition Assistance Program, or SNAP, and in a settlement with the state, the Patrick administration agreed to invest $30.2 million to modernize its computer system and fix longstanding problems with paperwork backlogs.

The new system, however, began cutting off people who were entitled to benefits.

In an e-mail statement Patricia Baker, of Mass Law Reform Institute (MLRI), said that between February 2014 to February 2015, Massachusetts lost 45,305 SNAP households (down 9.2%) and 90,931 individuals (down 10.5%). The decrease in MA individuals receiving SNAP between Feb 2014 and Feb 2015 is 9.5 times the national average.

McCue said the agency currently faces a backlog of 100,000 documents that were filed by food stamp recipients and are in need of review by the agency. Part of the problem is that cases in which documents were not reviewed can be automatically closed in the new system. McCue said it remains unclear exactly how many of the cases were improperly closed.

Many food stamp recipients have also been wrongly denied benefits as a result of the new system’s fraud prevention efforts. The newly automated system matched food stamp users with income information from the state Department of Revenue in an attempt to root out fraud. The effort created more problems when thousands of people who worked limited hours or minimally — such as election poll workers — were flagged by the system and cut off from benefits. They were unable to reach anyone on state call-in lines. Sudders suspended that portion of the program earlier this year, requiring those cases to be reviewed manually by a caseworker.

How to Advocate for Reinstatement

The state has deployed additional staff to “retool” their preexisting DTA Ombudsman office. MLRI is advising advocates or their clients to contact the DTA Ombudsman Sara Craven and her staff to fix individual cases or to notify them of systemic issues:  call 617-348-5354 or email to Sara.Craven@state.ma.us.

Mass Law Reform Institute is also asking to be kept apprised of any trends or systemic issues. That includes issues that repeatedly come up including DTA failing to pull up on-line SNAP applications, losing recertification forms, requesting verifications not required, and more. While DTA works to fix the individual cases, MLRI wants to know what patterns you are seeing and why it is happening  so they can track and report the systemic and policy issues to DTA Central, Please contact Pat Baker pbaker@mlri.org or Vicki Negus vnegus@mlri.org.

Sources and for More Information

-See the full Boston Globe article.
-Additional information from Boston Globe: Official calls food stamp system "an embarrassment", DTA increases staffing, overtime and Ombuds line to handle calls, FoodSNAPCoalition@masslawlists.org, on behalf of Pat Baker, MLRI, May 21, 2015.

Synergy Health Centers’ expansion in Massachusetts has been rapid — the chain has purchased 10 nursing homes since December 2012 — and with the expansion have come complaints.

State inspection reports of Synergy’s nursing homes routinely show striking increases in problems since the company arrived. In one home, a patient’s pressure sores were neglected for weeks. In another, racks of dishes and utensils floated in dirty water just before they were used to serve food. And in a third, there were not enough nurses.

At the Sunderland nursing home, the federal Centers for Medicare & Medicaid Services dropped the facility’s overall ranking in April from “below average” to “much below,” the agency’s lowest rating.

At the same time, Synergy’s nursing homes are paying hefty administrative fees to related companies, which are also owned by Synergy’s founders and chief executives, the company’s financial reports for Sunderland and Brockton indicate. That structure has become increasingly common among nursing home chains, a practice that elder advocates say decreases quality of care.

The Synergy experience underscores the increasing reach of corporate chains in nursing care and the mounting concerns of patient advocates about the quality of their services. Although some chains maintain high standards, others have faced complaints for slashing staff wages and citations for the level of care they provide.

Genesis HealthCare, one of the nation’s largest nursing home chains, bought competitor Sun Healthcare Group in late 2012, acquiring more than a dozen Massachusetts nursing homes. An uproar soon followed among its Massachusetts employees over the company’s “poverty wages” and unaffordable health care, according to the 1199SEIU United Healthcare Workers East union.

A similar dispute unfolded last year when Zenith Care Health Group, a small New York company, bought a nursing home in Lexington and workers walked off the job.

Massachusetts has become a magnet for out-of-state companies to expand their reach, as owners of smaller nursing homes struggle with paltry state payments for patient care, said Ann Marie Antolini, a vice president at Massachusetts Senior Care Association, a trade group that represents most of the state’s 420 nursing homes.

“We see this trend as a result of a challenging reimbursement environment in Massachusetts that has been making it more and more difficult for nursing home providers to invest in their workforces and in quality resident care,” Antolini said.

Scrutiny Lagging

Massachusetts health regulators acknowledged this month that they still have no timetable for intensifying scrutiny of nursing home sales and closings, even though the Legislature mandated stricter reviews 10 months ago.

The admission came as a member of a board that sets state health policy urged regulators to move more swiftly in light of the current acquisitions.“We have seen some sudden closures, and more of the for-profits coming in, and allegations about their quality of care,” said Dr. Alan Woodward, a member of the Public Health Council, an appointed body of academics, consumer advocates, and physicians.

State Senator Harriette Chandler, the Senate’s majority leader, said she is troubled that the law she championed last year has fallen by the wayside. “There are lives that are being jeopardized as a result of not having these regulations,” Chandler, a Worcester Democrat, said. “That’s why we did the law, so nursing homes would not be bought and sold literally in the dark of night, and nobody would have a chance to comment.”

Had regulators implemented the law, three of the most recent Synergy acquisitions — in Brockton, Revere, and Wilmington — would have received public scrutiny before the deals went through.

Chandler said she has spoken with health department officials and asked for a list of laws that have been passed but not implemented because the agency is still crafting regulations. Elder advocates lobbied for years to win legislators’ 2012 approval of a strengthened law governing nursing-home dementia care, but it took the health department nearly two more years to issue rules implementing that law.

Woodward and other council members said they are concerned that a recent executive order by Governor Charlie Baker could hamper the state health department’s ability to implement the rules and ensure quality care at nursing homes. Baker ordered a yearlong review in March of nearly all state regulations, with a mandate that none should exceed federal requirements, which are often less stringent than the state’s.

Sources and for More Information

-See Complaints follow nursing home chain’s expansion, The Boston Globe, May 4, 2015.
-See Mass. Health Regulators Lag on Nursing Home Scrutiny, The Boston Globe, May 13, 2015.

To shed light on the availability of state records on assisted living communities, seniors housing referral service, A Place For Mom (APFM), analyzed the openness and accessibility of those records in every U.S. state and the District of Columbia. They considered the amount of information available to the public, the ease of access to that information, and the frequency of state inspections or surveys.

The APFM survey is a wake-up call to Massachusetts senior care consumers and elder advocates: Massachusetts placed dead last (51 out of 51) in the rankings. As reported in a series of articles in Commonwealth Magazine, the Massachusetts Executive Office of Elder Affairs (EOEA) has largely failed to fulfill its oversight and inspection mandate, potentially leaving frail residents at risk. Recently-proposed EOEA regulations to change the certification procedures and standards for assisted living residences fail to address the on-going problems at the state’s facilities according to the Massachusetts Chapter of the National Academy of Elder Law Attorneys (NAELA).

Massachusetts assisted living residents often pay $5,000 per month or more for a "basic service package with additional charges as more services are needed." APFM's survey drives home the need for prospective resident to consider seeking the assistance of a care manager so that they can make truly informed decisions about assisted living options. They may also want to consult with a legal professional for help in evaluating the terms of the proposed admission agreements.

-Adapted from . Massachusetts Ranked Last Place in Assisted Living Oversight and More, Margolis & Bloom, LLP, May 05, 2015.

Air ambulance companies, which indisputably save lives, often in dramatic circumstances, have consistently raised their rates and aggressively expanded their networks, adding scores of expensive new helicopters. The business model has worked because health insurance has covered a large share of the bills.

Now changes in the air ambulance industry may leave patients more financially vulnerable. Private insurance companies that offer ambulance coverage may not cover the full cost of these ambulances, leaving more patients to pay the difference. And in recent months, those insurers, under pressure to cut costs, have been reducing reimbursements for air ambulances. Medicare has typically covered a smaller portion of the bills than private insurance, and Medicaid even less.

Using numbers in the company’s financial filings, Jonathan Hanlon, founder of Research 360, a firm that analyzes companies, calculated that one company, Air Methods, issued an average bill in 2014 of $40,766, compared with roughly $17,262 five years earlier. A law that deregulated the airline industry in the 1970s has prevented states from capping the amount air ambulances can charge.

Asked about the increase, Michael D. Allen, president of domestic air medical services at Air Methods, said charges had risen in part to offset the decline in insurance payments.

At the same time, profits are under threat from within. Strong revenue over the last decade fed explosive growth in the number of air ambulances, creating an inefficient system in which too many helicopters were chasing too few patients, according to some air ambulance operators and emergency care experts. One side effect may be that smaller, nonprofit air ambulance operators, which make up a significant portion of the industry and may charge less than their large commercial rivals, are finding it harder to survive.

Concern about future revenue recently prompted the air ambulance companies to seek help from Washington. The Association of Air Medical Services, an industry trade group, is promoting legislation that was introduced in the House of Representatives in February. Among other things, the bill would increase Medicare payments to air ambulance companies.

As many as 400,000 people are transported each year by air ambulances, the association estimates. The industry has undoubtedly brought quicker emergency care to certain, largely rural, areas, though the safety of air ambulances has also come under scrutiny, and crashes still occur.

Air Methods has been at the forefront of the expansion, earning a sevenfold increase in profit over the last 10 years. By its own calculations, Air Methods accounts for nearly 30 percent of all air ambulance revenue in the country.

-See the full Boston Globe article.

Nearly 400 families living in state-subsidized apartments managed by the Worcester Housing Authority (WHA) will soon be required to meet work or school requirements to avoid eviction - a smaller-scale version of a sweeping change quashed by the federal government last year. State-subsidized housing accounts for about 20 percent of units offered by the WHA.

This policy shift – approved by state officials appointed by Gov. Charlie Baker - applies to all families in the state-subsidized apartments except families whose members are all over age 55 and to individuals with a documented disability.

The 393 families who will be subject to the policy reside at the Curtis Apartments, Main South Gardens and other scattered sites throughout the city. The policy will require that one adult in each household either work 1,200 hours per year, go to school full-time or do a combination of the two adding up to 1,200 hours (an average of 23 hours per week). Families who do not comply will be subject to lease enforcement and termination.

Secretary of Housing and Economic Development Jay Ash said “We are seriously considering how to apply this program to other housing authorities across the state.”

DHCD Undersecretary Chrystal Kornegay said that while the program has buy-in from the corner office, one shouldn’t expect a rollout statewide anytime soon.

The new policy goes into effect Sept. 1, and the 1,200 hour threshold will restart each year for families following their annual summer lease recertification with the WHA.

-See the full Worcester Telegram & Gazette article.

City Hall is calling for more detox beds and better coordination on the availability of beds in a new initiative to help get ahead of the opioid addiction crisis.

Issuing a report on the city’s rate of addiction and available detox facilities, Mayor Martin J. Walsh said in a statement, “Too many Bostonians are all too familiar with the destruction that substance abuse addiction causes in our city’s families and neighborhoods. We see addiction’s devastation in our homes, at our workplaces and on our streets.”

The report, complied with Blue Cross Blue Shield, will be used as a “road map” for the city’s newly created Office of Recovery Services.

Recommendations in the report included creating a central source for information on available beds, more integrated care to reduce relapses and adding more beds for detox and residential treatment.

The Office of Recovery Services has been budgeted $300,000 to get started. The new office will work to improve addiction and recovery services and advocate for treatment options, according to the mayor’s office.

-See the full Boston Herald article.

The durable power of attorney may be your most important estate planning document. It appoints your agent or agents (called your "attorney-in-fact") to step in and act for you on financial and legal matters in the event you ever become incapacitated. It can permit them to pay your bills, make investment decisions, take planning steps, and take care of your family when you can't do so yourself.

In theory, the durable power of attorney is a relatively simple document. All it should need to say is the following:

I, Joe Blow, hereby appoint Janet Planet to step in for me in the event of my incapacity to handle my financial and legal matters.

But in fact most durable powers of attorney run to several pages and involve a number of important decisions. Now, two nationally-known estate planners, Jonathan Blattmachr and Martin Shenkman, have written a whole ebook just on powers of attorney: Powers of Attorney: The Essential Guide to Protecting Your Family's Wealth.

Some of the decisions you will need to make on your durable power of attorney include who to appoint, how many agents to appoint, and whether it should be "Springing" or current.

Springing or Current?

 The idea behind powers of attorney is that they will be used only when the person who creates it (the "principal" in legal speak) becomes incapacitated. Interestingly, traditionally powers of attorney expired when the principal became incompetent, the theory being that the attorney-in-fact stands in his shoes and can only do what he can do -- if he's incompetent, then so is his agent. Every state has passed laws providing for "durable" powers of attorney that survive the incapacity of the principal. But when should they take effect? One would think only upon incapacity -- a so-called "springing" power of attorney. In fact, we advise against springing powers of attorney because they create a hurdle for the agent to get over to use the document. When presented with a springing power of attorney, a financial institution will require proof that the incapacity has occurred, often in the form of a letter from a doctor. Obtaining that letter will be one more task the attorney-in-fact will have to carry out, often when already overwhelmed dealing with a parent's illness while still trying to stay employed and care for children. It can also mean a delay in access to funds needed to pay for care or to maintain a home. In most cases, if a client trusts someone enough to name her as his agent, he also trusts her not to use the document until the appropriate time. And if this trust is misplaced, then he can always revoke the appointment.

Check With Key Financial Institutions

One other important consideration is to see if any of the financial institutions with which you have accounts has its own power of attorney form. If so, make sure you execute their forms as well as a general durable power of attorney because banks and investment houses have been known to reject powers of attorney that are not their own.

-See the full Margolis & Bloom article.

For months, a safe house designed to rescue, protect and re-establish lives traumatized by sex trafficking had been shut down amid financial struggles. But its doors are opening once again.

Amirah is a nonprofit organization based out of Wenham that operates a safe house in the North Shore for sex trafficking victims around New England.

From October 2013 until last August, the organization had operated out of a house it didn’t own. Amirah closed last August, after which the organization launched a GoFundMe campaign to help raise $55,000 to buy the house and finance its reopening. 

They hit their goal four months ago and, with $75,000 now ready to go, the organization is putting a down-payment on the house to make it theirs permanently, according to Gregory Smith, a member of the organization’s board of directors.

They’re also hiring their first leader. “We had started the program, but all we had money for was a program director,” Smith said. “We took a step back and said, ‘until we can get this thing right, we aren’t going to move forward.’” The organization has tapped Stephanie Clark to serve as its first full-time executive director. Clark is a former small business owner and recently served as associate pastor at Calvary Christian Church in Lynn.

The organization’s plans don’t stop there. “We’ll be hiring a program director and an administrative person in the next 90 days, and the plan is to reopen the house by the end of the summer,” Smith said.
For more on Amirah visit the website: http://www.amirahboston.org/ or call 781-462-1758.

-See the full Salem News article.

Most seniors want to stay in their own homes as their physical abilities change. There are many good reasons to remain in one's long-time home as the years go by. We cherish our familiar surroundings. We're familiar with the services and businesses in our neighborhood. We rely on an informal support system of family, friends and neighbors as we continue to live as independently as possible.

But researchers caution that the decision to stay at home should not be made without thinking through all the pros and cons. For example, it's important to consider what would happen if we could no longer drive. Stephen Golant, a researcher from the University of Florida who has studied the housing needs of senior Americans for over 30 years, points out that a senior's long-time home may not be the best choice. Says Golant, "We need to think about two sets of feelings—not just feeling comfortable, but also being in a place where we feel capable of achieving our everyday needs, from self-care to buying groceries to reaching doctors, and don't feel that our lives are spinning out of control."

Many seniors discover that their homes haven't kept up with their needs as they deal with the common physical changes of aging. For example, stairs and other home hazards can lead to dangerous falls for people with mobility and sensory challenges. According to the Centers for Disease Control and Prevention (CDC), thousands of older adults die from fall injuries every year and millions more are treated for nonfatal injuries. Falls are the top reason seniors go to the emergency room. And over half of falls take place in the person's own home.

Fires are another concern. Older adults are at greater risk of being injured in a home fire. They may be physically less able to take quick action after a fire. Cognitive impairment or the side-effects of medication may affect their ability to make decisions. They may forget to turn off the stove, or fall asleep while smoking. Seniors are also at greater risk of criminal activity in the home. Unfortunately, many burglars and con artists target frail, vulnerable elders.

One first step is to remove Hazards and Add Safety Accessories. To help prevent accidents, perform a room-by-room safety inspection of the home. Make repairs and remove clutter throughout the home and outside. Inspect smoke alarms. Make safety improvements and additions, such as non-slip, non-glare flooring, low-pile carpeting and grab bars in the bathroom and night lights. Improve lighting in all rooms. Remove or secure area rugs.

Doing it yourself is not always the best way to go. Poorly planned and built features can prove useless, or even dangerous. For example, a ramp that is too steep and lacks safety features is worse than no ramp at all. Grab bars that are not solidly anchored can cause rather than prevent falls. If you are hiring a handyman or contractor to do some of the work for you, be certain the person or company you select is reliable and trustworthy. 

For more tips on how to make the home safer and tips on hiring a contractor, IlluminAge Communication Partners has created an Upgrade Your Home for Aging in Place checklist.

-Adapted from Your Home Suited for Aging in Place, Aging In Stride enews, IlluminAge Communication Partners.

Daily Table on Washington Street in Dorchester looks like a boutique supermarket. Carrots and squash fill wood crates, precooked bean soups and pastas line refrigerator cases, and a 7-foot window displays a bustling kitchen where chefs chop vegetables and cook chili. But unlike Whole Foods and Star Market, the new business isn’t built on profit margins or sales growth.

Daily Table bills itself as the first not-for-profit grocery store in the country with a mission to provide nutritious and affordable meals for low-income families. The store is expected to open soon, pending final permits.

The current planned prices — $1.19 for a dozen eggs, $1.99 for a block of cheddar cheese and 55 cents for a can of tuna — are considerably lower than the cheapest alternatives at traditional supermarkets. The store can offer lower prices because it sources surplus foods or goods nearing their “sell-by” dates from farmers, supermarkets, manufacturers, and food distributors, who would rather donate or sell their products at steep discounts than toss them in the trash.

So far, Rauch has built relationships with suppliers to divert garbage-bound products to his shelves. He’s careful to point out that it doesn’t mean the food is “bad,” expired, or unsafe to eat.

A vendor at Haymarket, for example, donated a couple hundred pounds of summer squash he intended to throw away after the food didn’t sell. Daily Table expects to sell it for 59 cents a pound. Rauch said he has also purchased vegetables that grocery stores reject because of blemishes or other cosmetic problems that don’t affect the quality of the product.

Daily Table scored a deal on raisin bran cereal flakes because the boxes had a sell-by date only a few months away. He intends to sell the cereal for 79 cents a box.

Daily Table purchases about half of its products at reduced prices. The store is an approved organization of the Greater Boston Food Bank, and some of the products are acquired through the agency.

The store is membership-based, and customers must provide their ZIP codes to shop. Rauch said he intends for the store to predominantly serve people in the surrounding neighborhood and may have to exclude shoppers from other communities later.

The store initially made headlines in 2013, when Rauch first unveiled his plan to sell products that were past their display-code dates. Some criticized the idea, which they saw as an attempt to sell “old” food to impoverished communities. But so far, Rauch said, Daily Table has not needed to source products past their sell-by dates, though he remains open to the idea as long as the food is safe and healthy to consume. A longtime veteran of the food industry, Rauch argues that the codes are a tool for retailers and manufacturers to track their products and rotate stock, not an indicator of health safety limits.

Daily Table is opening at a time when more companies and organizations are seeking ways to divert extra food, said Sasha Purpura, executive director of Food For Free, a nonprofit based in Cambridge that aims to bridge the gap between food waste and hunger.

A state regulation that took effect in October prohibits businesses and institutions from disposing of more than one ton of food waste per week. Purpura said her organization, which picks up surplus food and delivers it to banks and other agencies, has received an influx of calls from groups that want to unload food.

Meanwhile, Rauch is raising funds to open two more stores in the Boston area.

-See the full Boston Globe article.

Address and Contact Information

450 Washington Street
Dorchester
617-506-0219
e-mail: info@dailytable.org
Website and to join: http://dailytable.org/

Locate 1.2 million people. Find even the thousands of them who don’t speak English or don’t have a place to live. Get them to fill out a 26-page application. Process those forms. And get it done by the end of the year. That is the unprecedented mandate facing state officials this year: to scour the MassHealth rolls and make sure that all the enrollees are still eligible.

Officials stumbled at first with an attempt to reenroll 500,000 people in just three months. There were long waits at the MassHealth call center and long lines at the community health centers. Thousands of other recipients simply failed to do anything. In the end, officials extended deadlines, added staff, and changed policies.

“This was new for us,” said Marylou Sudders, the state’s secretary of health and human services. “We didn’t know what to expect of 1.2 million people.”

The daunting project is a consequence of the 2013 software failure of the Massachusetts Health Connector. The Connector website was supposed to calculate whether people qualified for MassHealth or for another type of coverage, but it was unable to determine anyone’s eligibility. That forced MassHealth to halt its usual process of confirming eligibility, which involves reenrolling recipients monthly on a rolling basis. As a result, everyone who was on MassHealth stayed on MassHealth, regardless of income increases.

Now the federal government, which pays for half or more of MassHealth costs, is requiring the state to get its house in order. And Governor Charlie Baker is counting on the “redetermination” process to reap big savings — at least $250 million to $300 million in the calendar year — by culling those who no longer qualify.

“I don’t believe any other jurisdiction in the country has had to redetermine so many people in the same period of time,” said Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All.

“I think the idea that patients can do this on their own is just not realistic,” said Sue Joss, executive director of the Brockton Neighborhood Health Center. “They have to go somewhere for help, and we’re happy to do that. But it’s just overwhelming.” At one point, as many as 70 to 80 walk-ins were streaming into the Brockton health center each day, on top of the 45 with appointments, Joss said.

To help, MassHealth trained 1,300 “certified application counselors” who work in health centers, hospitals, and community groups. The state allowed people to file for extensions to June 30. They doubled staff at the MassHealth call center to shorten wait times. And they gave the health insurers lists of members who had not responded, allowing the insurers to contact them and file extensions for them.

The state budget allocated $14 million for all aspects of the redetermination process, with three-quarters of the money coming from the federal government.By early May, the crunch had eased, as thousands filed for extensions.

The 158,000 who did not respond were disenrolled. But they can get back on the program, with retroactive coverage, if they make contact with MassHealth before June 30.

In July, MassHealth will start reaching out to the next 500,000 enrollees.

-See the full Boston Globe article.

Medicare covers hospice care if you meet certain criteria. Hospice care is comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient and outpatient care, and services for the terminally ill person's family.

In order to qualify for the hospice benefit, you must meet the following criteria:

• Have Medicare Part A;
• The hospice medical director (and your doctor, if you have one) must certify that you have a terminal illness, meaning that your life expectancy is six months or less;
• You sign a statement electing to have Medicare pay for palliative care, such as pain management, rather than care to try to cure your condition;
• Your terminal condition is documented in your medical record; and
• You receive care from a Medicare-certified hospice agency.

If you are considering hospice care, speak with your doctor about finding a Medicare-certified hospice agency. The hospice medical director and your doctor will certify your eligibility. You must sign a statement electing hospice care and waiving curative treatments for your terminal illness. The hospice team of providers must consult with you to develop a plan of care. The team includes a hospice doctor, a registered nurse, a social worker and a counselor.

Hospice can be provided in the home or in an inpatient facility; you do not have to be homebound to qualify for the hospice benefit. The hospice benefit covers the following services related to your terminal condition:

• Nursing services
• Skilled therapy services
• Home health aide services
• Durable medical equipment and medical supplies
• Short-term inpatient care to give relief to your caregivers
• Short term inpatient care to manage symptoms and control pain
• Medical social services
• Some prescription drugs
• Spiritual or religious counseling care
• Nutrition and dietary counseling

The hospice benefit is always covered under Original Medicare. Even if you have a Medicare Advantage plan, Original Medicare Part A will cover your hospice care. Your Medicare Advantage plan will continue to pay for your care that is unrelated to your terminal condition. 

Original Medicare covers most costs associated with hospice care. You will be responsible for paying up to $5 for outpatient prescription drugs covered through the hospice benefit (prescription drugs related to pain relief and symptom control). You also will pay a copay of no more than 5 percent of the Medicare approved amount for each day of inpatient respite care.

While you have hospice, you can still get Medicare coverage for treatment of all illnesses and injuries unrelated to your terminal condition. However, the costs you usually pay for services will apply.

Medicare will cover the hospice benefit as long as you continue to qualify for hospice care. If you receive 180 days of hospice care, you must have a face-to-face meeting with a hospice doctor or nurse practitioner to confirm that you still qualify for hospice care. After that, you must continue to have these meetings before the start of each subsequent 60-day benefit period. You also can end hospice care at any time and elect to receive curative treatments for an illness.

-From  How does Medicare cover hospice care?, Dear Marci e-newsletter, The Medicare Rights Center, May 04, 2015.

The American College of Physicians (ACP) has issued a new policy position paper offering recommendations for achieving healthcare equality for lesbian, gay, bisexual, and transgender (LGBT) patients.

Published online May 11 in the Annals of Internal Medicine, the ACP statement calls for support for transgender rights and same-sex marriage and opposes so-called conversion therapy, which attempts to change an individual's sexual orientation. Its publication comes at a time when the Supreme Court is deliberating legalization of marriage for couples of the same sex.

Among the article's highlights, the ACP recommends that nondiscrimination and antiharassment policies include sex identity, a construct independent of sexual orientation. The organization also recommends that public and private health benefit plans include comprehensive transgender healthcare services and provide transgender persons with the same covered services provided to other beneficiaries.

In addition, the ACP supports civil marriage rights for same-sex couples and also recommends that the definition of family include those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship; therefore, patients should be able to determine who may visit and who may act on their behalf during their stay in a hospital or other medical facility. They further call for research on LGBT health disparities and approaches for reducing them, and recommend that medical training programs incorporate LGBT health issues into their curricula.

Finally, the ACP opposes the use of conversion, reorientation, or reparative therapy for the treatment of LGBT persons. They note that this therapy has no evidence of benefit, as well as some evidence of harm, especially among youth. Two states (California and New Jersey) and Washington, DC, have banned its use for minors.

Wayne J. Riley, MD, president of the ACP and clinical professor of medicine at Vanderbilt University School of Medicine in noted that the new policy position paper complements the recently updated Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, which he described as "sort of a primer on providing culturally competent care to LGBT communities."

"We look upon this as a two-pronged thing: one, to provide a medical textbook specific to LGBT care in the Fenway Guide, and also in terms of our health and public policy position, to really make a statement that LGBT care is important," he explained.

-See the full Medscape summary article.

State programs aimed at helping homeless families are costing cities and towns millions in education transportation costs, according to a new report released this month by the office of State Auditor Suzanne Bump. The audit focused on the roughly 1,700 families living in hotels and motels around the state through an emergency shelter housing program.

Under the federal McKinney-Vento Act of 2002, school districts must pay to transport homeless students from shelters to ongoing educational services in their home communities. The audit found cities and towns are paying hefty sums to transport children sheltered within their borders to schools in their hometowns. The report calls for the Legislature to fully fund mandates related to the homeless shelter housing programs in the future.

“Cities and towns across the commonwealth are struggling to deliver quality services to residents on lean budgets,” Bump said in an announcement Wednesday. “Unpredictable and uncontrollable costs like these make this job all the more difficult.”

The Legislature began setting aside money to reimburse cities and towns for the transportation costs after 2011, but the amount was reduced in recent years, leaving municipalities to pick up an estimated $7.1 million in unreimbursed costs in fiscal 2014, according to the audit.

Some communities must also expand educational services to accommodate incoming students. For example, administrators in Natick, Brockton and Attleboro established after school programs specifically for homeless students at hotel and motel housing, or for students who have to wait for transportation.

 “I guess on a personal level, I think that busing the kids to their originating community is the right thing to do so they can continue to have that sense of normalcy by going to school with their friends,” Natick Town Manager Martha White said. “I think that’s a compassionate response to the problem, but it’s very costly for the community. A quarter of a million dollars is not easy to absorb, and there are some communities facing much bigger impacts.”

-See the full MetroWest Daily News article.

As the Legislature considers a proposal by Governor Charlie Baker to regulate ride-hailing services, advocates are calling on lawmakers to toughen the bill so it requires companies such as Uber and Lyft to accommodate wheelchair users and other riders with disabilities. The measure is meant to end a long fight over how ride-hailing services should be regulated, and it has the support of the companies.

The bill only briefly addresses access for people with disabilities, however, saying the Department of Public Utilities would have the power to regulate the accessibility of the services, without listing any specific requirements.

That has advocates worried. “All of these systems . . . are hardly paying any attention to accessibility,” said Christine Griffin, executive director of the Disability Law Center. “If these companies said ‘We’re not going to pick up women or African-Americans,’ all the people supporting them would be running away. No one wants to look at this as a civil rights issue, when in fact that’s what it is.”

Uber and Lyft do not offer vans that are wheelchair-accessible in the Boston area, though many of their drivers’ vehicles can fit small folding wheelchairs. Lyft’s website lists other companies that offer accessible vans; Uber recently partnered with existing taxi vans with wheelchair lifts under pilot programs in certain neighborhoods of Chicago, Houston, Philadelphia, Los Angeles, New York City, San Diego, San Francisco, and Washington, D.C.

Company officials said Uber instructs its drivers to comply with federal disability requirements and gives them tips on how to accommodate passengers with disabilities. They also said the company was exploring how it might introduce wheelchair vans in Boston. But Uber cautioned that adding such vans could be difficult, since most of its drivers use their personal vehicles and relatively few people own such vans.

Other modes of transportation have their own problems with accessibility.

A review in 2013 found that only one of the 100 supposedly accessible privately owned taxi vans in Boston met federal standards, and today, only 18 of the vans have been retrofitted to meet federal standards, said a spokeswoman for Mayor Martin J. Walsh.

Some who use smaller wheelchairs said they love Uber because it affords them a higher level of independence. And riders with vision impairment praised Uber’s smartphone app, which they said works well with phones’ text-to-speech functions.

-See the full Boston Globe article.

The policy director of a local think tank who has spoken with “whistleblowers” says the feds are probing the state Health Connector to see if the Patrick administration misled them about the state’s troubled Obamacare website in order to keep taxpayer funds flowing to Massachusetts.

Joshua Archambault, director of health care policy at the conservative Pioneer Institute, said his group has been in touch with the whistleblowers and is preparing a report, based in part on information they provided.

The Baker administration has confirmed that it has received a federal subpoena for the Connector’s records. Gov. Charlie Baker’s office said the subpoena was issued in January a few weeks after the Swampscott Republican took office after former Gov. Deval Patrick. “The administration received a subpoena regarding the Health Connector’s difficulties dating back to 2010, and we are fully cooperating with the Department of Justice,” Baker spokeswoman Elizabeth Guyton said in a statement.

Baker said his administration is “going to absolutely do everything that we need to do” to comply with the DOJ inquiry, but said his focus is on fixing a system that is still plagued by problems.

Baker has applied to the Obama administration for a waiver from the Affordable Care Act so the state can maintain flexibility in regulating its small-group health insurance market.

Baker has made fixing the glitch-ridden website a priority during his first months in the Corner Office. Repairs to the site and the cost of placing people on temporary insurance are estimated to run in the hundreds of millions of dollars.

-See the full Boston Herald article.

The state’s beleaguered child welfare agency is facing an unmanageable backlog of appeals from caregivers accused of abuse and neglect that advocates say could leave at-risk kids languishing in the system and stall long-awaited adoptions for years.

The Ripples Group, which is working under a $200,000 contact with the state’s Office of the Child Advocate, recently released the findings in a preliminary report. It lacked specific data, including the exact number of so-called “fair hearings” the Department of Children and Families is handling, but it pointed to a number of troubling trends, among them:

• DCF has seen a “steep increase” in the number of people determined by the agency to have abused or neglected a child who are now appealing those decisions, overloading an already burdened system. “The number of backlogged cases is too high for the entire process to qualify as timely,” the report warns. “In other words, backlogs are likely to grow if precautions are not taken.”
• Hearing officers aren’t making decisions in a “timely” manner, and likely won’t reach mandatory deadlines in the “coming months and years.”
• Roughly one in every four of these cases is ultimately reversed, raising questions with some advocates about whether DCF has been too zealous in its pursuit of abuse allegations.

“It’s about making sure the system works in a timely fashion, and it shouldn’t take this long,” Erin G. Bradley, executive director of the Children’s League of Massachusetts, said of the delay of cases.

“We don’t want anybody’s rights to be trampled on,” Bradley said, “but the fact that it takes so long to make a determination is hurting the children who can potentially be stable, adopted and living with families.”

Spokeswoman Rhonda Mann acknowledged that DCF is facing a “significant backlog” of 2,600 open cases. But officials also appeared to tamp down the report’s alarms. According to its figures, DCF was carrying nearly 3,430 open cases five years ago — 800 more than it does now — and it recently hired its 12th hearing officer, compared to just five in 2010.

The number of appeals, however, is growing. DCF figures show it took on 1,916 hearing requests last year, a 57 percent spike from 2011, when it had just over 1,200.

DCF officials did not address the report’s findings that nearly one-quarter of the requests are reversed, saying they did not have that data. But they stressed the requests only make up a “small percentage” of all abuse and neglect cases. For example, there were 24,500 “supported” reports of abuse and neglect in 2014, less than 8 percent of which were challenged in an appeal.

But some observers say it’s a symptom of a system that’s moved too aggressively to pull kids from families in the wake of the death of Jeremiah Oliver, the 5-year-old Fitchburg boy who was found dead after social workers failed to regularly check up on him.

“The system is burning itself out when in reality the ones that need the help can’t get the help,” said Mary T. Jean, an advocate who represents dozens of people each year on appeals before DCF, at least one of whom she says has waited seven years for a decision. “If they’re saying it’s one in four, that shows how badly they’re supporting false claims.”

-See the full Boston Herald article.

The infographic below shows that Massachusetts is below the national average in giving children who are in the child welfare system the opportunity to live with members of their extended family. This contributes to more kids leaving the system (aging-out) without the support of a permanent family. And unfortunately, when kids age-out without this support they are less likely to finish high school and more likely to end up homeless or even in jail. The infographic also shows racial disparities in kinship care in the commonwealth.

For More Information

Every Kid Needs a Family: Giving Children in the Child Welfare System the Best Chance for Success, released this month by the Annie E. Casey Foundation, national partner of MassBudget's KIDS COUNT project, explores strategies for providing more children in the foster care system with the opportunity to grow up in a family. The progress on these issues in Massachusetts, and the continuing challenges, are described in MassBudget's recent report Family Ties: Exploring Massachusetts's use of Kinship Foster Care for Children in the Child Welfare System and a related report by KIDS COUNT Advisory Council member the Massachusetts Law Reform Institute: The Ties That Bind: Strengthening, and Reducing Racial Disparities in, Kinship Foster Care in Massachusetts.

-Adapted from Infographic: Every Kid Needs a Family, Noah Burger, MassBudget, May 19, 2015.

Spurred by concerns about  fraud, state officials are studying a controversial proposal to require welfare recipients to be fingerprinted to receive benefits. House Minority Leader Brad Jones, R-North Reading, wants the state Department of Health and Human Services and the Department of Transitional Assistance, which oversee welfare benefits, to study the use of fingerprints and other biometric identifiers to deter fraud.

House lawmakers voted this month to include a pilot project in the upcoming state budget. Jones said the technology could save millions of dollars by preventing individuals from claiming benefits for which they don’t qualify — a problem highlighted by two recent scathing state audits.

Advocates for the poor say the system makes an already humiliating process of applying for welfare even more unpleasant, putting the needy through a level of scrutiny that is commonly associated with criminals. The practice does little to deter fraud, they say, and drives away people seeking assistance.

As a result of the recent audits, lawmakers approved a proposal last year that requires photos on electronic benefit transfer cards (editor’s note: which has proved problematic- see previous coverage: US Orders Mass to Address Food Stamp Photo ID Confusion, MGH Community News, December, 2014). The state’s welfare agencies have ramped up investigations of fraud and other abuses.

But fingerprinting is a controversial means of cracking down on fraud. Recent studies suggest the practice is often too expensive and does little to stem abuses in state-level public assistance programs. North Carolina is studying a similar proposal for a new state ID program, but several states that had fingerprinted welfare recipients as far back as the 1990s — including Texas, Connecticut and New York — have stopped the practice, according to published reports. States that abandoned the program cited cost and little evidence that it curbed abuse.

-See the full Newburyport News article.

Who coordinates the proliferating number of health care helpers variously known as case managers, care managers, care coordinators, patient navigators or facilitators and health coaches?

For decades, critics have lamented the fragmented American health care system: Your cardiologist doesn’t know which medications your endocrinologist has prescribed. The hospitalists directing your care don’t know whether you will need transportation for follow-up visits after you are discharged. Meanwhile, no one has told your primary care doctor you’re in the hospital.

Now, the Affordable Care Act and other attempts to make health care more effective and efficient (and less expensive) have created incentives and penalties that should, in theory, encourage one hand to know what the other is doing.

Thus, you may have a care manager through Medicare Advantage; nationally, about 30 percent of Medicare beneficiaries have enrolled in such programs. Your primary care physician’s office may offer care coordination; Medicare now reimburses for such services. Hospitals, accountable care organizations, Medicaid programs, home care agencies, senior centers and other community organizations have followed the care coordination trend.

“It’s infused the entire health care system,” said Joe Baker, the president of the Medicare Rights Center in New York. “This is definitely good for patients,” he added. “I don’t know anyone who’d rather sit around in an emergency room or be admitted to a hospital if that can be prevented.”

Checking in with patients to help them manage chronic illnesses, find the services they need, understand their drug regimens, order medical equipment and adopt healthier habits could improve their well-being and ward off intensive and costly medical interventions.

But at this early stage, people who work with consumers and caregivers say, the multiplying number of coordinators is also creating some difficulties. It may not be clear which coordinators have expertise or authority and more fundamentally, they may not be talking to one another.

“It’s not so much that there are too many cooks in the kitchen, it’s that the cooks are not always communicating,” Mr. Baker said. “We need to set up more rigorous protocols or structures, so we don’t have this who’s-on-first problem.” Perhaps, he suggested, a “dominant care manager” should guide the team.

Several experts described these issues as growing pains, the inevitable disorder that accompanies substantial change in a complex system. It will get better, they said. Being contacted by several people whose job is to help you navigate the health care system is a good problem to have.

But in the interim, families encountering these new faces and titles have to ask questions: What is each coordinator’s role? What can he or she actually do? How long will the manager/facilitator remain involved?

The United Hospital Fund has assembled a Family Caregiver’s Guide to Care Coordination; Among its recommendations is to keep a log — on paper, on a computer or phone, via a patient portal — of who has called when, what each coordinator is working on, who has spoken to whom.

It seems an additional burden on people trying to get well, and on their often overtaxed caregivers, but it may promote coordinated coordination.

“Everybody’s trying to help,” said Cheri Lattimer, executive director of the Case Management Society of America,. “But is everyone doing it in the most efficient and effective way for the consumer and the family? Or are we just confusing the issue?”

-See the full The New York Times article.

Mindfulness-based cognitive therapy (MBCT) is superior to therapy focused on exercise and healthy eating in patients with treatment-resistant depression, new research shows. Conducted by investigators at the University of California at San Francisco and led by Stuart Eisendrath, MD, professor of clinical psychiatry, the randomized controlled trial also showed that MBCT also acts on parts of the brain involved in depression.

The findings were presented at the American Psychiatric Association (APA) 2015 Annual Meeting.

Known as Practicing Alternatives to Heal Depression, the study was a single-blind randomized trial that included 173 patients with treatment-resistant major depressive disorder (TR-MDD), which was defined as failure to remit with two or more antidepressants.

Patients had a Hamilton Depression 17 (HAM-D 17) total score of at least 14, were taking an antidepressant, were not receiving psychotherapy or practicing extensive yoga, and not have a substance abuse problem. They also could not have a history of psychotic disorder or a Mini-Mental State Examination score of less than 25.

After screening, the investigators randomly assigned patients to 1 of 2 group-based interventions: MBCT, which involved learning mindfulness techniques, including sitting meditation and included elements of cognitive-behavioral therapy, or the Health Enhancement Program (HEP), which focused on physical fitness, nutritional counseling, and music therapy.

After 8 weeks of the intervention, both groups improved, but the change in HAM-D score in the MBCT group was 36.6% vs 25.3% for the HEP group (P = .01). As for treatment response, again the MBCT group came out on top, with 29.58% of the sample achieving a 50% or greater reduction in HAM-D total score compared with 17.19% in the HEP group (P = .0293).

"In this population who are treatment resistant, getting people to remit is a challenge, so it wasn't surprising that we had this result," said

The results of this study were actually better than the third or fourth stages of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, Dr Eisendrath. noted.

-See the full Medscape summary article.

The concept that depression is a result of low brain serotonin levels and, therefore, that selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for the disorder is a myth, says a UK psychiatrist.

Moreover, David Healy, MD, professor of psychiatry, Hergest Unit, Bangor, Wales, United Kingdom, believes that SSRIs were a treatment looking for a condition and that doctors and patients were co-opted into the myth by clever marketing, resulting in better treatments being sidelined.

"This history raises a question about the weight doctors and others put on biological and epidemiological plausibility. Does a plausible (but mythical) account of biology and treatment let everyone put aside clinical trial data that show no evidence of lives saved or restored function?," Dr Healy asks.

The editorial was published online April 21 in the BMJ.

Doctors, Patients Co-opted

One of the main issues with the rise of SSRIs, he says, is that "more effective and less costly" treatments have been marginalized. Furthermore, research into other, more plausible explanations for depression ― as illustrated, for example, by the antidepressant potential of ketamine ― has been stifled.

One Size Does Not Fit All

Commenting on the editorial for Medscape Medical News, Georgia Hodes, PhD, postdoctoral researcher in neuroscience at Icahn School of Medicine at Mount Sinai, in New York City, observed that "Clearly there are a percentage of people in whom these [drugs] have been extremely helpful, but at the same time, there's a large percentage of the depressed patient population whom these drugs are just not effective for," she said.

She noted that, for example, the research on ketamine that Dr Healy pointed to suggests that there are potentially different mechanisms underlying different types of depression. "I think it's pretty clear from the research that's been done for the past 50 years or so that it's a heterogeneous population...and that we need to start finding out what is actually wrong with these different types of people who suffer from depression," she said.

Dr Hodes believes that what is needed are "biologically relevant" tests for mental illness in general, and depression and anxiety in particular, to identify biomarkers that will indicate what kind of depression a person has and, consequently, the best treatment for them."Right now, it's all based on someone going in and talking about their symptomatology without there being any biological basis for this, and there's no biological basis even for what drug you give the person," she said.

Dr Hodes explained that this is partly due to an "inability of the field to move forward from SSRIs," adding: "They weren't looking for a mechanism of depression, because they figured that they had it." Pointing to recent research indicating that depression is linked to both inflammation and glutamate signaling, Dr Hodes said: "One of the things that I think has held people back is that we always think about depression as being in the brain." "So when they're looking for biomarkers, they're trying to look for biomarkers that are the same in the blood as in the brain, but we've done some research that suggests it's also a condition of the body." She concluded: "Maybe we should just be focusing on what's happening in the body. This might be a way not only to treat people without having to get drugs into the brain but also to find better biomarkers."

-See the full Medscape summary article.