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MGH Community News |
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MGH Community News |
| June 2016 | Volume 20 • Issue 6 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Health Safety Net Cuts Not Reversed As reported previously (HSN Cuts Update and HSN Expiring for Those Eligible for ConnectorCare Who Fail to Enroll, MGH Community News, May 2016), Governor Baker plans to reduce income limits for the Health Safety Net (HSN) program starting this month and eliminate the state contribution, now $30 million. His budget for the 2017 fiscal year beginning July 1 includes the cuts. State Sen. Jason Lewis submitted an amendment that would have delayed some aspects of the cuts for nine months. This week efforts to delay the cuts or study them further did not make it through the legislative conference committee- they were held in conference by the conferees, which essentially means they are dead. The conference committee budget would transfer $15 million to HSN. Last year about 274,000 people were enrolled in the program; advocates say the eligibility changes would affect almost 60,000 people. The income limit for the program has dropped to $72,250 from $97,000 for a family of four, and require more families and individuals to pay a deductible before benefits begin. State officials say almost all those who will lose benefits are eligible for subsidized insurance through the state’s Obamacare agency, the Health Connector, but haven’t enrolled despite rules requiring them to do so. Supporters of the program generally don’t object to those requirements, but argue that many others in the Health Safety Net can’t pay medical bills even with Connector insurance or aren’t eligible for Health Connector coverage at all; elderly people who can’t afford to supplement their Medicare coverage, for example, were responsible for 20 percent of Health Safety Net bills last year, according to state figures. Health Safety Net participants must get their care at a hospital or community health center, and supporters say the cuts will leave hospitals picking up more of the tab for patients who can’t afford to pay. Hospitals and insurers already pay $165 million to fund the program and hospitals alone are responsible for any shortfall. Last year, when the state contributed $30 million, the shortfall was $40 million; hospitals estimate it will be $100 million without state money. |
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The program, formerly called Free Care, was originally meant for people without health insurance. Since state health reform in 2003, the number of residents without coverage has fallen; last year 8 percent lacked insurance at least once during the year and 3.6 percent weren’t covered at the time of the state survey.
Still, undocumented immigrants, people with inadequate health insurance, seniors on Medicare and those with very high medical costs still need help, advocates say. -See the full Cambridge Day article. -Additional material from Health Safety Net in Conference Committee Report, Neil Cronin, Mass. Law Reform Institute, June 30, 2016.
Disabled Veterans Exempt from SNAP Time Limit & Additional SNAP Advocacy Help Good news for veterans! The USDA Food and Nutrition Service (FNS) released new guidance this month, dated 5/20/16, but circulated just before Memorial Day. Veterans who receive VA Disability Compensation Benefits should be considered "physically or mentally unfit for employment" - regardless of the disability rating. This means that a veteran who qualifies for VA Compensation at 10% rating or higher is exempt from the SNAP 3 month time limit. The veteran does NOT need a medical report form documenting he or she is medically unfit for work. If you have a veteran who is receiving federal VA Compensation benefits, please notify DTA. While DTA's OnLine Guide on the ABAWD exemptions has not been updated yet, we are hopeful it will get updated soon. FNS advised all states of their policy clarification. Note, the state-funded Veterans Services Benefits (aka Chapter 115 Benefits) - cash assistance benefits available to low income Massachusetts veterans and dependents - are not the same as federal VA Compensation benefits. Receipt of the Chapter 115 benefits does not automatically trigger the exemption. The veteran or dependent may need to secure a medical report form unless homeless or meeting some other exemption. For more information on VA Compensation and other veterans benefits, go to Veterans Administration VA Compensation 101 For more on state-funded Chapter 115 Veterans Services and other state benefits for veterans, See MA Attorney General's Resource Guide for Veterans and Service Members Additional Advocacy Help Mass Law Reform Institute (MLRI) has a special project this summer with a grad student/MS candidate from the Tufts Friedman School of Nutrition, Samantha (Sam) Hoeffler. Sam's research and policy advocacy project involves:
-Patricia Baker, Mass Law Reform Institute, Food/SNAP coalition listserv, June 1, 2016 and June 9, 2016.
Long-Term Care Coverage for Veterans
As you are aware, the U.S. Department of Veterans Affairs (VA) provides health care benefits to veterans, including preventative services, diagnostic and treatment services, and hospitalization. The VA also offers a number of long-term care options through its health plan.
Some services are limited to certain veterans: nursing home care and domiciliary care are not automatically available to all veterans enrolled in the VA health plan. The following veterans automatically qualify for unlimited nursing home care:
A service-connected disability is a disability that the VA has officially ruled was incurred or aggravated while on active duty in the military and in the line of duty. The VA must rule that your illness/condition is directly related to your active military service, and it assigns each disability a rating. The ratings are established by VA regional offices around the country. The VA may provide nursing home care to other veterans if space permits. Veterans with service-connected disabilities receive priority. There are also state-run veteran's nursing homes. The VA provides funds to states to help them build the homes and pays a portion of the costs for veterans eligible for VA health care. The states, however, set eligibility criteria for admission. A domiciliary is a VA facility that provides care on an ambulatory self-care basis for veterans disabled by age or disease who are not in need of acute hospitalization and who do not need the skilled nursing services provided in a nursing home. Domiciliary care is available to low-income veterans with a disability. -From Elder Law Answers.
Massachusetts Senate Expands Veterans Benefits and Protections The Massachusetts Senate this month passed a bill giving veterans preference for subsidized housing, protecting state workers called to military service and providing various benefits for veterans and their families. The bill would also create a new state-level position overseeing housing for veterans, including at the Holyoke and Chelsea Soldiers' Homes. The bill passed the Senate unanimously, 37-0. A similar bill passed the House last month, and differences will now need to be worked out before the final bill goes to Gov. Charlie Baker for his signature. The bill would create a new Office of State Veterans' Homes and Housing within the Department of Veterans' Services to deal with all matters related to veterans' housing, including the soldiers' homes, which provide residential long-term care to veterans. The goal of the new office and its director is to ensure that best practices are shared between the two soldiers' homes and throughout the state when it comes to housing veterans. The bill includes a range of other provisions. It expands a public service scholarship for children of Vietnam-era prisoners of war to children of all prisoners of war. It allows children of all public employees who were killed on the job to apply, rather than just children of veterans, police officers, firefighters and correctional officers who were killed. The bill would prohibit employment discrimination against veterans, rather than just active military personnel, as is the current law. It gives veterans preference for eligibility for low-income housing, including housing for seniors and people with disabilities. Currently, veterans only get preference for housing in the community where they live, and this would extend that statewide. It allows state employees who leave for military service for more than 30 days to continue to be paid their salary minus their military pay and to have their seniority protected. It provides a property tax exemption for family members of National Guardsmen who died during active military service. Numerous amendments expanding the bill were added on the Senate floor. Among them were provisions expanding which family members can receive Gold Star license plates; allowing municipalities to establish funds with voluntary donations by taxpayers to help local veterans; making families of soldiers who died on active duty but not in combat eligible for financial assistance for funerals, housing and other needs; expanding eligibility for veterans' tuition rates; and creating a commission to study issues related to accessible housing for veterans with disabilities. -See the full masslive.com article.
MBTA Fares Increasing - Including THE RIDE When MBTA fares go up July 1, The Ride will go from $3 to $3.15. Premium fares, those charged for same day trip requests or changes and for areas more than three-quarters of a mile from a T station or bus stop, increase from $5 to $5.25 — half the increase the MBTA originally proposed. Still, some say the increase will be a challenge for Ride users — many of whom are low-income.“We know that people are struggling to meet basic needs, so any increase in transportation is going to have an impact, and unlike other modes of transit there is no monthly package or monthly pass for The Ride,” said Carolyn Villers, the executive director of the Massachusetts Senior Action Council. Villers said her group is pushing for an income-based fare. She called the recent fare hike “modest,” but saidmany people who use the service haven’t fully bounced back from increases to The Ride in 2012, when fares were doubled from $2 to $4, though were later reduced by a dollar after pushback from advocates and a sharp drop in ridership. To help those most burdened by the fare increase, the MBTA is trying to find alternatives for Ride users. That would save money both for customers and the transit agency. The T spends about $46 to subsidize each trip on The Ride, compared with just $0.61 for each subway ride on the Orange, Red and Blue lines. Last fiscal year, that amounted to $97 million for more than 2 million rides. Michael Lambert, the deputy administrator for transit for MassDOT and the T, said transit officials are looking to private partnerships to ease the cost of The Ride.“We are trying to create the incentive, trying to create the business case for companies to adopt and include accessible vehicles,” Lambert said. “If a taxi company were to include a significant number of accessible vehicles in their fleet, that company would become very attractive to our customers and would almost be guaranteed a level of demand that would certainly help defray the cost of the vehicles and more likely turn a profit.” The T has a pilot program that allows Ride customers to hail subsidized rides with handicapped-accessible taxis at cheaper prices. The T plans to expand the program in the summer. The transit agency is also working with ride-hailing companies Uber and Lyft to offer a similar service. Lambert said the state would cover up to 80 percent of the cost of handicapped accessible vehicles to companies that purchase them. Jim White, the chair of the Access Advisory Committee to the MBTA, called these efforts a win-win, but he added these alternatives need to have strong safety protocols, and he’s working to make that happen. White also said the transit system needs to become more accessible, because oftentimes disabled riders can’t access stations. “Boston’s MBTA system, being one of the oldest systems in the country, hasn’t quite caught up to being fully accessible,” White said. “That’s why paratransit system is there.” -Access the full WBUR story.
The Right to an Interpreter in All Agencies that Get Federal Funding Clients have a right to an interpreter when applying for SNAP and cash assistance from DTA, as well as MassHealth, and Social Security, receiving care from hospitals and health clinics, attending public schools as well as when seeking services from other local, state and federal government agencies.
Mass Law Reform Institute (MLRI) language access attorney, Tere Ramos, and their AmeriCorps member, Zach Ezor, recently created a video, "You Have the Right to a Free Interpreter." Feel free to distribute this widely and share with your clients and organizations that serve Spanish-speaking clients: http://www.masslegalhelp.org/spanish/language-rights MLRI will be producing short videos in other languages as well soon. And, if you have forgotten your 7th grade Spanish, here's the English version of the text of the video (but no video): http://www.masslegalhelp.org/language-rights DTA Interpreter Requirements And be sure to look at DTA's Online Guide section on Interpreter requirements, available here: http://webapps.ehs.state.ma.us/DTA/PolicyOnline/%21SSL%21/WebHelp/userguide_test.htm Go to: Home > Cross Programs > Interpreter Services > Interpreter Services Overview To comply with federal law, the Department must advise applicants and clients...of the right to professional interpreter services regardless of language, national origin or noncitizen status and must provide interpreter services to clients whose primary language is not English. Interpreter services must be provided to clients with Limited English Proficiency (LEP) at the first point of contact. Clients with LEP or requiring an American Sign Language (ASL) interpreter must not be turned away or told to return with an interpreter. A client who presents either in person or by telephone with an adult intending to act as an interpreter, must be advised that DTA will provide a professional interpreter free of charge. After being informed, the client may decline the use of professional interpreter services and choose to have the adult serve as an interpreter. Children over age 12 may interpret only to schedule an appointment. Children age 12 and under must not be asked to interpret for any purpose. -Patricia Baker, Mass Law Reform Institute, FoodSNAPCoalition@masslawlists.org, June 14, 2016.
Undocumented Immigrant Programs Implementation Blocked by Supreme Court The U.S. Supreme Court deadlocked this month on a challenge to President Obama’s programs to spare millions of illegal immigrants from deportation, handing Obama a crushing defeat on an issue that has loomed large during his presidency and this year’s political campaign. The 4-4 split on the court upholds a lower court ruling that halted Obama’s November 2014 effort to allow certain unauthorized immigrants to live and work in the United States legally. The decision shattered the hopes of 4 million unauthorized immigrants across the United States, including 45,000 in Massachusetts from Brazil, El Salvador, Guatemala, and other nations. Most are the parents of US citizens or green card holders, according to the Migration Policy Institute. At the White House, Obama called the decision “heartbreaking” but said immigrants who would have qualified for his programs should not fear imminent deportation because they are “low priorities” for immigration enforcement. “As long as you have not committed a crime, our limited immigration enforcement resources are not focused on you,” he said. Obama warned that Congress eventually will have to tackle the problem of the nation’s 11 million immigrants here illegally. Less than half would have benefited from his programs. Addressing immigration had been one of Obama’s earliest campaign promises. But with less than seven months left in his term, he signaled there was little that he could do. He said the issue would be up to voters when they pick his successor. The Supreme Court’s tie effectively halted implementation of two immigration programs Obama created in November 2014 after Congress failed to pass an immigration bill. The programs would have granted temporary work permits to an estimated 3.6 million parents of US citizens and green card holders (the Deferred Action for Parents or DAPA program) and also expanded the existing Deferred Action for Childhood Arrivals or DACA program to 274,000 immigrants who arrived in the country as children but did not qualify for under existing rules. In addition to work permits, the programs would have allowed them to apply for driver’s licenses, and offered a respite from the fear of deportation. But before the programs went into effect, Texas and 25 other states filed a federal lawsuit to block them. In February 2015, US District Judge Andrew Hanen in Texas issued a temporary injunction to halt the programs, and the Fifth Circuit Court of Appeals later upheld his decision.
The Supreme Court ruling on Thursday let those rulings stand and did not set a national precedent. The decision did not decide whether Obama’s programs were legal but instead left in place the lower court’s injunction pending further litigation, according to the Mexican American Legal Defense and Educational Fund, a group that joined the appeal before the Supreme Court. Though Obama said low-risk immigrants should not fear immediate deportation, many advocates were unsure how long this policy would last. The presumptive Democratic nominee for president, Hillary Clinton, supports Obama’s immigration policies but GOP candidate Donald J. Trump had vowed to rescind the immigration actions and deport all immigrants here illegally. In Massachusetts, Attorney General Maura Healey and Mayor Martin J. Walsh of Boston expressed disappointment while the Brazilian Women’s Group, Agencia Alpha, and other advocates for immigrants vowed to mobilize voters for the November elections. Many fear Trump would carry out mass deportations. Walsh vowed to move forward with a July 23 free clinic in Roxbury, where advocates had planned to help eligible immigrants apply for Obama’s programs. Now, volunteers will screen immigrants to see if they are eligible to apply for another form of assistance. Many immigrants who had hoped to apply for Obama’s programs are from Central American nations beset by some of the highest homicide rates in the world, the legacy of civil wars that ravaged the region, weakened government institutions, and led to an increase in organized crime. -See the full Boston Globe article.
Possible Loophole to Send Women on Sec 35 Commitment to MCI Framingham Again Lawyers for the commonwealth appear to be pushing for a loophole in one of Gov. Charlie Baker's marquee opioid-legislation reforms, according to civil-liberties groups that are suing the state. For more than 30 years, public officials and advocates had sought to end the practice of sending women addicted to drugs, who have not been charged with a crime, to the prison at MCI Framingham when the primary Section 35 facility for women is full. After lobbying the Legislature for the reform, Gov. Baker signed a law in January that removed MCI Framingham as the designated overflow facility. But earlier this month, a lawyer for the commonwealth argued in U.S. District Court that the law still allows civilly committed women to be sent to MCI Framingham if the Department of Public Health or Department of Mental Health approve it. "It either suggests that the governor is not aware of what the lawyers are doing or -- but it's kind of hard to believe -- that he was deliberately misleading the people and the Legislature when those statements were made," said James Pingeon, litigation director for Prisoner Legal Services of Massachusetts. "But someone is being misleading." Prisoner Legal Services of Massachusetts and the ACLU of Massachusetts are arguing in the case, Doe v. Patrick, et al, that the January law unequivocally prohibits civilly committed women from being sent to MCI Framingham. A spokeswoman for Gov. Baker and the attorney representing the commonwealth in the case contend that the point is moot and that the lawsuit should be dismissed because the Department of Public Health and the current administration have no intention of sending civilly committed women to MCI Framingham. But the ACLU of Massachusetts and Prisoner Legal Services of Massachusetts, which represents the plaintiffs in the lawsuit, point to an exchange during a June 10 hearing as evidence that the commonwealth is attempting to reserve the right to use MCI Framingham. The judge in the case called the commonwealth's argument "an escape function" from the January law. "Does the commonwealth construe the statute as now proscribing (prohibiting) the use of Framingham?" Judge Douglas Woodlock asked Assistant Attorney General Bryan Bertram, who is representing the commonwealth. "As it was used before, with no DPH or DMH approval? Then, yes," Bertram said. "So it can be used under certain circumstances," Woodlock said. "If DPH and DMH approves it," Bertram replied. Bertram later stated that it would be highly unlikely that the DPH or DMH would change their regulations to allow Section 35 women to go to Framingham again. The plaintiffs in the case say that is not good enough. "What that approach really is saying is 'trust us,'" said Matt Segal, legal director of the ACLU of Massachusetts. "And given that there is this decades long history of imprisoning women at Framingham ... we are at a point where we don't think 'trust us' is enough." For decades, the practice of civilly committing women to MCI Framingham has symbolized society's perception of addiction as a crime rather than a disease. Family members, police officers, and doctors can petition judges to civilly commit a person with an addiction to a secure facility against their will if the person is deemed to be a danger to themselves or society. Historically, many women have willingly allowed themselves to be committed to MCI Framingham because there were no other treatment options available to them. They were never suspected, charged, or convicted of committing a crime, but they were housed for up to 90 days with inmates awaiting trial for violent crimes. Unlike other civil commitment facilities, the prison is not a clinical program, and the committed women there received little treatment beyond a forced detox. Between 2008 and 2013, the number of Section 35 women sent to Framingham rose 533 percent from 43 to 229. "Inevitably, the community beds have not been enough and the judges or the administration have opened the door again to Framingham," Pingeon said. -See the full Lowell Sun article.
Baker Reverses Patrick Policy- State Police Can Detain Immigrant Suspects at ICE Request In a major policy shift, the Baker administration will allow State Police to routinely check with federal immigration authorities about the status of suspects who are already in custody on state criminal charges, reversing the practices put in place by former Governor Deval Patrick. Governor Charlie Baker, a Republican, said in a statement he has decided to change the course imposed by Patrick, a Democrat, so that troopers can help federal law enforcement combat terrorism, gangs, and other criminal activity. The new policy will not allow troopers to arrest someone or take them into custody only on immigration issues, but they will be allowed to contact Immigration and Customs Enforcement directly to learn if ICE considers the person a priority target, the administration said. “As before, the State Police will not be enforcing federal immigration law nor will they inquire about immigration status; they will now be able to assist in detaining for our federal partners individuals who pose a significant threat to public safety or national security,’’ Baker said in the statement. Patrick refused to allow state law enforcement participate in a federal program called “Secure Communities’’ because of concerns that ICE was not focusing on people with extensive criminal histories, but instead targeting otherwise law-abiding people. The administration said that federal law enforcement has revamped its approach — it’s now called the “Priority Enforcement Program (PEP)” - and it is time for Massachusetts to follow suit. Under the current plan, federal officials will seek detention of people for violating immigration laws under six broad categories:
Analysis: What We Know About the Policy (MIRA) Massachusetts State Police Officers may:
Limitations Contained in the Written Policy:
Advocacy The MIRA Coalition is asking for help to document the impact of this policy. If you are stopped or arrested by the State Police and you feel your rights were violated, please let us know using this FORM (in English, Spanish and Portuguese). Questions? -See the full Boston Globe article.
State of the State Budget The state fiscal year ends June 30, but the state budget will not be in place for the start of fiscal year 2017. The Legislature has passed a $5.3 billion budget bill filed by Governor Baker to keep state government operating through July, and even make emergency local aid payments if cities and towns can adequately demonstrate they would be severely cash-poor without the checks. The conference committee budget avoids dramatic cuts by relying on a series of financial maneuvers to close the big gap in expected tax revenue. The conference committee budget is austere, but includes modest increases in spending on the troubled Department of Children and Families and state-funded programs to address the scourge of opioid overdoses, lawmakers said. Gov. Baker now has 10 days to review and sign or veto. Any sections vetoed would return to the legislature for possible overrides.
Watch for more detailed analysis next month. -Adapted from Weekly Roundup - The British Are Leaving, State House News Service, June 24, 2016 and $39.1b state budget plan avoids dramatic cuts, The Boston Globe, June 30, 2016.
Physical Activity and Recreational Resource Guide Franciscan Children’s Hospital recently updated their resource guide: Physical Activity and Social Service staff can also find it on the staff access area of our website under Activities (youth) or Recreation (Youth) -Thanks to Clorinda Cottrell for sharing this resource.
SAMHSA Issues Mental Health Parity Fact Sheet The Substance Abuse and Mental Health Services Administration has released a fact sheet to help consumers understand their rights under the Mental Health Parity and Addictions Equity Act. The brochure reviews the law’s parity protections, how consumers can find out more about their health plan’s benefits and coverage, and their right to appeal a claim if denied. -From Government Affairs Update June 29, 2016, Heather R. Gasper, Partners Healthcare, Government Affairs.
Medicare Reminder: What is a Benefit Period? A benefit period is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row. The benefit period is not tied to the calendar year. If you go into the hospital or SNF after one benefit period has ended (more than 60 days after you left), a new benefit period begins. There is no limit to the number of benefit periods you can have, or how long a benefit period can be. Benefit periods also affect how much you may pay for your inpatient hospital or SNF stay. You must meet your Part A deductible at the beginning of each benefit period as well as pay a daily coinsurance depending on how many days you stay at the hospital or SNF during one benefit period. After you meet your Part A deductible at the beginning of the benefit period, the first 60 days of your inpatient hospital stay are covered with no daily coinsurance. Similarly, if you qualify for a Medicare-covered SNF stay, you will pay nothing for the first 20 days of your SNF stay within a benefit period. In 2016, Original Medicare Part A costs for hospital and SNF stays are:
If you have questions about where you are in your benefit period, look at your most recent Medicare Summary Notice (MSN), which is a summary of health care services you have received over the past three months. If you do not have your most recent MSN, you can call 1-800-MEDICARE to request a copy. -From What is a benefit period? Dear Marci, Medicare Rights Center, June 13, 2016.
Student Health Insurance Program Update At a recent Health Connector Board meeting, the Board discussed the Student Health Insurance program (SHIP). Since 1989, all college students in the Commonwealth have been required to have health insurance, and each school is required to offer a SHIP. Students are able to waive the coverage if they have comparable coverage elsewhere, such as a parents’ employer plan or, since the passage of the ACA, MassHealth. Since the passage of the ACA, fewer students have been enrolling in SHIPs, in large part likely due to newly-gained access to MassHealth. In an effort to keep premiums in SHIP plans reasonable, and retain access to MassHealth, the Commonwealth has begun a pilot program to enroll MassHealth students into Premium Assistance. Like other MassHealth Premium Assistance programs, students enroll in their private plan (in the case, the school’s SHIP), and MassHealth helps them pay for their premiums and cost-sharing. MassHealth plans to roll this out to all full-time college students receiving MassHealth coverage in coming months and years. More information: download a SHIP Brochure and FAQ. -From A Healthy Blog, Massachusetts Health Care for All, June 14, 2016.
Editorial: MassHealth Reform Must Make Behavioral Health a Priority Treating people who suffer from depression, bipolar disorder, addiction, and other behavioral health conditions is frequently a losing proposition for the Massachusetts nonprofits that offer therapy, counseling, and related services. They, and their employees, are not compensated nearly enough for helping people to become stable and productive, and - critically - to stay out of the hospital. That’s because the majority of community-based clinics serve large populations of patients insured by MassHealth, the state insurance program for low-income and disabled residents. MassHealth reimburses providers at rates substantially lower than what private insurers pay out — less than what it costs behavioral health centers to provide care. A recent survey by the Association for Behavioral Healthcare, which represents about 85 providers throughout the state, found that more than three-quarters of its member organizations lost an average of $555,000 on outpatient services during the 2015 fiscal year. Considering that the average agency budget was $4.5 million, that’s seriously thick red ink. As a result, many outpatient centers have reduced staffing and limit the number of patients they accept. Inadequate reimbursement rates also are making it harder for them to attract and retain psychiatrists, who are needed to prescribe medications. More than half of adult patients now wait at least a month to receive an assessment from a psychiatrist or nurse practitioner. It’s an ominous trend, but not especially surprising. Treatment for behavioral health conditions has traditionally been undervalued by policy makers and insurers, and misunderstood by the public. Perceptions are evolving, but not quickly enough. Governor Charlie Baker, however, has an opportunity to send a message by making community-based behavioral health care a priority in his impending overhaul of MassHealth. Baker is expected to unveil a draft version of an ambitious reform proposal, which will call for dumping the current fee-for-service payment model in favor of a system that allots health care providers set budgets for patient treatment. In overhauling MassHealth, the state must recognize the importance of keeping the lights on at behavioral health outpatient clinics. If their capacity to offer services continues to diminish, more patients will end up in a hospital emergency room, or — as too often is the case — they will go without any treatment. The consequences of those outcomes will be expensive — for people whose lives are paralyzed by mental illness or substance abuse, for the state budget, and for society as a whole. -See the full Boston Globe editorial.
Editorial: Proceed with Caution on Drug Copay Discounts For several years, Massachusetts has allowed pharmaceutical companies to offer consumers discounts on brand-name drugs as a way to reduce or eliminate out-of-pocket costs. Such incentives, known in the industry as copay assistance, have long been permitted in every other state. But drug discounts had been banned in Massachusetts on the premise that they might steer patients toward more expensive medications - instead of toward comparable generics, or competing brand-name treatments sold at lower prices. That changed in 2012, when legislators approved lifting the prohibition on copay assistance. They also called for a study of the copay assistance program’s impact on health care spending. Unfortunately, that study never happened. The original measure came with a so-called sunset provision - meaning that the ban on discounts would be reinstated. Initially, that sunset clause was postponed until July 2017. Now, with rising out-of-pocket costs making it more difficult than ever for some patients to afford their prescription drugs, there’s a move on Beacon Hill to add language to the state budget that would do away with the sunset clause altogether. Such an action, though understandable, given the financial pressures on patients, would constitute a premature endorsement of copay assistance programs. Before drug discounts are made a fixture in Massachusetts, the study called for in 2012 should be undertaken by the state’s Center for Health Information and Analysis. It’s important to determine whether these discounts actually save money, or mainly serve to sell more higher-priced products. In the meantime, consumers can still take advantage of the manufacturers’ discount programs for at least another year, and beyond that, the Legislature retains the option of again delaying reinstatement of the ban while a study is underway. -See the full Boston Globe editorial
Globe Spotlight Team: Closing Psychiatric Hospitals Seemed Humane, but the State Failed to Build a System to Replace Them By almost any measure, Massachusetts has lost the leadership role it once had in mental health care. In a state that prides itself on leadership in human services and compassionate government, it has come to this, a Spotlight Team investigation has found: threadbare policies, broken promises, short-sighted decisions, and persistent underfunding over decades. As a result, the seriously mentally ill, including those at greatest risk of harming others or themselves, are far too often left in the care of parents, police, prison guards, judges, shelter workers, and emergency room personnel — almost anyone, in fact, but professionals trained to deal with their needs. Families of these sufferers find themselves up against obstacles that earlier generations didn’t have to face. Fifty years ago, the seriously mentally ill might have been treated - and locked away - in one of the public psychiatric hospitals that once dotted Massachusetts. Today, nearly all of those institutions have been bulldozed or boarded up — and many had to be, having evolved into inhumane asylums for people who are, in the great majority, no threat to anyone. But the hospitals were not replaced with anything resembling a coherent care system, leaving thousands of people with serious mental illness to navigate a fragmented network of community services that puts an extraordinary burden on them to find help and to make sure they continue getting it. Even those beset by the most ferocious inner demons are routinely pinwheeled from hospital to hospital, therapist to therapist, court to court, jail to jail, then sent off into the world with little more than a vial of antipsychotic medications and a reminder to take them. This is the choice Massachusetts has made, a choice with deadly consequences. Since 2005, more than 10 percent of all Massachusetts homicides in which a suspect is known were allegedly committed by people with a history of mental illness or its clear symptoms, the Spotlight Team determined by building the first-ever database of such cases. At least 139 people in this state have died violently at the hands of a person with a diagnosed mental illness or strong indications of one during this period. And last year, the mayhem grew even more frequent, as 14 of the 95 homicides in the state with identified suspects - nearly 15 percent - were allegedly committed by people who were or appeared to be mentally ill. Few have paid a higher price in this crisis than the loved ones of people with a serious, often undertreated, mental illness. At least 18 parents allegedly have been killed by their mentally ill children in Massachusetts since 2005, the Globe review found, and 21 children allegedly were killed by their mentally ill parents. In all, people with a history of mental illness have been accused of killing at least 79 relatives and significant others since 2005. Often, these victims were the very people who tried the hardest to get help for their mentally ill loved ones. Indeed, family members are often all that stand between seriously mentally ill people and disaster — making sure they keep appointments, take their medications, and have a place to stay, while remaining vigilant for the next crisis. At the same time, thousands of those without family members to stand by them are relegated to streets, shelters, prisons, and county jails. They crowd emergency room wards and hallways. This is, of course, not just a state but a national crisis. However, it is worse here than most would imagine. Massachusetts spends less per capita on mental health care than any other New England state except Rhode Island, and much less than some states of comparable means and politics — such as New York, according to a Kaiser Family Foundation study. By this and other critical measures, Massachusetts has forfeited the leadership it once was known for in mental health care. Marylou Sudders, the top official overseeing mental health care in the state, can’t even bring herself to call the state’s patchwork of emergency rooms, group homes, clinics, and therapists a “system,” admitting that mental health care in the state is both poorly organized and grossly underfunded. Though many individual care providers do excellent work, she said, they are islands with little surrounding support. In New York State people who are severely mentally ill and have a history of violence, or threatening violence, may be required to undergo outpatient treatment under a court order or face involuntary hospitalization. In this, New York is like 45 other states, and Massachusetts is among the outliers, along with Connecticut, Maryland, and Tennessee. The New York law and those enacted in other states are designed to cope with “revolving door” mental health patients who are potentially violent or suicidal and land in emergency rooms after psychotic episodes, then refuse to take prescribed medications or see a therapist. It is called Kendra’s Law, named for Kendra Webdale, a young woman who died in 1999 after being pushed in front of a moving New York City subway by a man with untreated schizophrenia. The law has been in effect for more than 15 years, and studies show it has improved the quality of life for mental health patients with extreme maladies such as schizophrenia and bipolar disorder while saving taxpayer money through reduced hospital visits. While other states have similar provisions, most experts regard New York’s as among the most successful, in part because the state has robustly funded programs for patients receiving court-ordered treatment and has increased general spending on outpatient mental health programs. The firmly held belief that people with a serious mental illness are no more likely to be violent than others has fueled opposition to new laws that could help families like the Chieros, who struggle to persuade their mentally ill loved ones to accept treatment and take their medications. For years, some advocates for people with a mental illness have helped block all attempts to require mentally ill people with a history or grave risk of violence to take their prescribed medications, to the point where Massachusetts is one of only four states without such a provision, a gap defended by the advocates as a matter of personal liberty. “The right to refuse treatment is vital,” said Susan Fendell of the Mental Health Legal Advisors Committee, speaking against a mandatory outpatient treatment bill during a State House hearing last year. But Lisa Dailey, an attorney for the Treatment Advocacy Center, a nonprofit group that advocates for such treatment for some people with mental illness, was just as adamant. “This is a cruel and dangerous status quo,” she said. -See the full first installment of the Globe SpotlightTeam report.
Commentary- GOP Expected Health Care Plan Cuts Coverage for Millions and Ends Protections for People with Pre-Existing Conditions Six years after passage of the Affordable Care Act (ACA), U.S. House Speaker Paul Ryan recently announced the outline of a Republican plan to replace it. Dubbed “A Better Way,” Ryan’s plan repeals the ACA protections that stop insurers from denying coverage to people with pre-existing conditions, replacing them with historically ineffective and costly high-risk pools; cuts subsidies that make insurance premiums affordable especially for millions of low-wage working families; eliminates prohibitions that prevent insurers from imposing arbitrary payout limits for people who experience major illnesses or accidents; promotes high-deductible health plans; and reduces federal funding for state Medicaid programs through per capita caps. Ryan’s plan is not expected to include dollar amounts, which means detailed analyses of the plan’s effects are impossible, and it cannot be scored by the Congressional Budget Office. Following is the statement of Families USA Executive Director Ron Pollack on Ryan’s plan: “Ryan calls his plan ‘A Better Way.’ But sentencing tens of millions of people with pre-existing conditions to coverage denials by insurance companies, or dumping them into ineffective and costly high-risk pools, is not a better way. Jeopardizing the health coverage of over 20 million people who recently secured it is not a better way. Cutting state Medicaid funding that places 72 million of our most vulnerable men, women, and children at risk of losing coverage is not a better way. “It is also not a better way to promote high-deductible plans that are unaffordable for moderate-wage working families. And it is not a better way to force people with major illnesses into a no-coverage zone by allowing insurers to place arbitrary caps on how much they will pay out when people need significant care. “Ryan’s refusal to put actual dollar amounts behind his proposal masks how devastating the effects will be. But make no mistake, Ryan’s approach is not a better way forward, but a bitter path backward that returns us to the bad old days when vast swaths of Americans were left to the tender mercies of the insurance industry and could not afford needed care. “There is a ‘better way,’ and that is to take the existing Affordable Care Act and work across the aisle to improve it so that each and every American has access to quality, affordable health care.” -From Families USA. See the full press release.
New Regulation Prohibits Discrimination in Health Care Aging advocates working to promote health equity got some good news this month. After much anticipation, the U.S. Department of Health and Human Services (HHS) released final regulations that seek to transform care for underserved communities by ending discrimination in health care services and settings.<> The regulations codify Section 1557 of the Affordable Care Act (ACA). In drafting the statute, Congress recognized the need to ensure all individuals have access to health services and insurance, regardless of their race, color, national origin, sex, age or disability. It applies to every health program or activity that receives HHS funding, including Medicare and Medicaid managed care plans, aging network entities like home health care agencies, health clinics, community health centers, and most physicians. HHS itself and state Medicaid and public health agencies also are covered. The final rule is effective July 18, 2016, with additional time available only in limited circumstances. The regulation will enhance protections for diverse older adults in several key ways. Enhanced Language Access Requirements Those who are limited English proficient (LEP) should see enhanced access to their health care information. The new regulation requires that, in any significant mailing, health care entities must include taglines in at least the top 15 languages spoken by LEP individuals in that particular state. The taglines say that free language assistance services are available. They must also be posted in offices and on websites, along with a notice of consumer rights. Health care entities must also offer timely free access to qualified interpreters and must translate certain “vital” communications. Prohibition on Sex DiscriminationSection 1557 is the first law of its kind to prohibit sex discrimination in health care settings. Sex discrimination includes discrimination based on gender identity. In an important step forward for health equity, all health care entities are required treat individuals consistent with their gender identity. The regulation clarifies that categorical or automatic exclusions of coverage for all health services related to gender transition are prohibited. Further, insurers and providers may not deny or limit coverage or treatment for health services that are ordinarily or exclusively available to individuals of one sex to a transgender individual for whom such services are medically appropriate. The protections against discrimination on the basis of sex also extend to discrimination based on pregnancy and sex stereotyping, including stereotyping of gender roles. No Expansion of Current Religious ExemptionsWhile it does not replace existing regulations, like the Religious Freedom Restoration Act (RFRA), HHS reiterates that Section 1557 itself contains no religious exemption, and it does not expand on any of the existing exemptions. Medicare Part B Providers are Not Included as Covered EntitiesJustice in Aging is extremely disappointed that the regulation retains a compliance exclusion for Medicare Part B providers. In commentary, the Office of Civil Rights notes that it does not believe the regulation is the appropriate vehicle to modify the Department’s position on excluding Medicare Part B providers as covered entities. HHS asserts that the practical effects of the Part B exclusion will be limited because many Part B providers receive other forms of Federal financial assistance; however, we believe this analysis of the practical impacts misses the point that there is no justification for such an exclusion. Justice in Aging will continue to advocate to ensure all Medicare providers will be subject to Section 1557’s nondiscrimination requirements.
-See the full Justice in Aging analysis.
Post-Detox Treatment in Short Supply Providing Access to Addictions Treatment, Hope and Support or PAATHS, a Boston Public Health Commission program, opened three years ago as a place to help anyone at any level of recovery or addiction navigate the fractured treatment system. You can go to PAATHS if you live under a pile of blankets beneath a bridge or you can go there from the suburbs with your mother at your side. It doesn’t matter if you’ve been kicked out of a sober home for behavioral issues, for a mental health problem or for repeatedly using. “You can just walk in and we work with you, regardless,” said Lia Beltrame, PAATHS program director. “There’s no charge for our service. We can find help for you if you have no insurance or a high co-pay.” Those claims stand out a like a beacon in a treatment system fraught with a lack of beds, insurance quandaries and complex rules. With the state’s opiate epidemic showing no signs of slowing down, a shortage of long-term treatment beds remains the biggest problem, Beltrame said. A 2014 analysis found there’s only room in Massachusetts rehab facilities for 17 percent of those leaving detox units, according to the Center for Health Information Analysis, an independent state agency. “It’s a four-lane highway emptying into a one-lane dirt road,” said Charles Faris, president and chief executive officer of Spectrum Health Systems Inc., one of the largest treatment organizations in Massachusetts. Finding the beds that are available is even harder because the system is so complex. Now, new programs, like PAATHS, are cropping up to help people make connections and get the help they need. Gov. Charlie Baker’s administration has been adding state-funded beds since he made fighting the opioid epidemic his top priority when he arrived at the Statehouse. Since 2014, the number of public and private licensed beds has gone up, with 45 new detox beds, 83 new clinical stabilization services beds, commonly known as rehab, and 113 new long-term recovery beds, according to the state. The addition of beds however, doesn’t do much to change the overall picture of the treatment system. For those seeking recovery, there is a five-step general treatment path that moves from the most acute medical need, which is a detox center, to a rehab facility, transitional placement, halfway house and then sober home. Outpatient counseling, day programs, and medicines to help with cravings are available along the way. Emergency rooms, jails and morgues see the fallout when patients fall through the gaps. ‘There are no beds’ Massachusetts’ treatment system, though, considered one of the best in the country, according to many experts, is shaped like an hourglass, wide at the first phase of treatment, detox. But people stay in detox only about five days, long enough to physically withdraw from substances such as benzodiazepines, heroin or alcohol. Then the stock of rehab beds — where people spend two to five weeks — drops to 380 beds for rehab or clinical stabilization service (CSS), and 312 beds for transitional support services (TSS). More beds are on the way, however, with at least 800 expected in a year or two, according to David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems Inc. These beds will be private, for-profit, however, and will accept insurance and private payers for both mental health and addiction services, Matteodo said. -See the full Cape Cod Times article.
'Knock and Talk' Program in Salem to Take Aim at Heroin Crisis Buried in the numbers of Salem’s upcoming budget is a plan to tackle the regional opioid crisis in a way that has seen success in other cities: putting those who almost lost the battle in front of others who are winning it. Mayor Kim Driscoll is proposing to add two new police officers, plus two social workers who would work for the police department on a “knock and talk” program similar to those begun recently in Revere and neighboring Lynn. The idea is simple: sit down with an addict and talk to him or her. But the window to have an effective conversation with someone in need of help is incredibly tight, Driscoll said. “The window of time that somebody may have had something happen and is willing to go into recovery is so short and critical, that we want to access it with the right people reaching out,” the mayor said. “If the police department ends up at an address with an overdose, the next day they’re back with somebody in recovery and a social service provider who can help an individual navigate the system,” Driscoll said. “That has proven to be, in some communities, more successful intervention - not talking to a police officer, but talking to someone in the shoes they’re in.” -See the full Salem News article.
Health Tip- Stroke Symptoms Specific to Women Stroke, a disease that occurs when the brain does not get the blood and oxygen it needs in order to function, is among the leading causes of death and disability in the United States. Strokes affect women more than men, and risk factors and symptoms present differently between the sexes. While high blood pressure and smoking increase both men and women’s risk of stroke, pregnancy, lupus, migraine headaches, birth control pills, and hormone replacement therapy are risk factors unique to women. There are also certain stroke symptoms that are only seen in women. Knowing the warning signs of a stroke can help you or your loved one seek care in a timely manner. Symptoms seen in both men and women:
To read more about how strokes affect women, check out this article on WebMD. -From Dear Marci, Medicare Rights Center, June 13, 2016.
Patterns of Response in Parents of Children With Cancer: An Integrative Review Abstract Problem Identification: To identify patterns of response of parents in relation to taking care of their child with cancer. Synthesis: The results of the studies were analyzed, identifying a vast number of patterns of response developed by the parents. These patterns of response were analyzed, compared, and split into four themes. Conclusions: Using this methodology, a wide range of behaviors, attitudes, and competencies associated with the circumstance of parents caring for a child with cancer could be identified. Implications for Practice: Knowledge of the patterns of response will enable nurses to lead parents through a healthy transition process in caring for their children with cancer. -See the full Medscape summary of the Oncology Nurses Forum article.
Targeted Psychotherapy Effectively Treats Complicated Grief Specialized therapy effectively treats complicated grief, while the addition of citalopram relieves co-occurring depressive symptoms, researchers report. "Complicated grief is a chronic serious condition that occurs in about 7% of bereaved people, amounting to about 10 million people per year," Dr. M. Katherine Shear of Columbia University School of Social Work in New York City told Reuters Health by email. "It differs from 'regular' grief in the way an infected wound differs from a wound that is healing. Troubling thoughts related to the death and/or excessive avoidance of reminders of the loss slow or halt the process of adapting to the loss, and this leads to persistent intense grief," she said. By contrast, depressive symptoms, which may or may not be present in individuals with complicated grief, include "persistent depressed mood, anhedonia, worthlessness, and psychomotor and neurovegetative symptoms," Dr. Shear and colleagues explain in JAMA Psychiatry, online June 8. A targeted 16-week psychotherapeutic intervention has been shown to be effective in treating complicated grief, according to the authors. The protocol includes history taking, psychoeducation about complicated grief and its treatment, work with memory and pictures, and imagined conversations with the deceased. -See the full Medscape summary article.
Therapists Often Discriminate Against Black and Poor Patients, Study Finds Minorities and lower-income individuals can face numerous challenges in getting treatment for depression and other mental health problems. They may lack insurance or transportation to a therapist's office; they may experience stigma in their communities around mental illness that prevents them from seeking care. A new study finds that these groups face yet another barrier to mental health care: Therapists may be less likely to see them. To study whether therapists had biases, researchers hired actors to record voice messages for 640 therapists in New York. In all the messages, the actors read scripts saying they had been feeling down, had insurance and would like to make an appointment. The scripts varied the names, vocabulary and grammar to reflect race and class differences. The researchers waited one week for the therapists to return the calls, which went to a voice mailbox created for the study. The researchers recorded whether the therapists agreed to see the new client and whether they could accommodate the desired time, which was a weekday evening. Middle-class black women and men were about 30% and 60% less likely, respectively, than their white middle-class counterparts to hear back from a therapist agreeing to see them. Working-class individuals fared even worse: Women and men, regardless of race, were about 70% and 80% less likely, respectively, to get an appointment, compared with white middle-class individuals. "Psychotherapists are not immune to the same stereotypes that we all have, and I think they could become even more relevant for psychotherapists than for other professions [both medical and nonmedical], because they are embarking on this intimate, potentially long-term relationship with these [clients]," said Heather Kugelmass, a doctoral student in sociology at Princeton University. Kugelmass is the author of the study (PDF), which was published in the Journal of Health and Social Behavior. -See the full CNN.com story.
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