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MGH Community News |
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MGH Community News |
| August 2017 | Volume 21 • Issue 8 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Diana Tran,617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
MA Caregiver Advise, Record, Enable (CARE) Act Coming Soon- Hospitals to Communicate with Patient-Designated Caregivers As reported previously, (Massachusetts CARE Act Becomes Law, MGH Community News, December 2016) the Massachusetts Caregiver Advise, Record, Enable (CARE) Act was signed into law late last year. The law is effective either November 8, 2017 or when DPH issues guidance that sets forth compliance deadlines that are expected to include clarification on the caregiver designation process and documentation requirements. What is the CARE ACT?The CARE Act stands for Caregiver Advise, Record, Enable (CARE) Act. This new Massachusetts law allows a patient over the age of 18 who has been admitted as an inpatient at an acute hospital to give permission for a hospital to provide medical information to a designated caregiver. There are three main parts to the law.
The CARE act makes it easier for caregivers to get the information they need and be better prepared to help care for their family or friend Frequently Asked Questions
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-Adapted from Massachusetts CARE Act Fact Sheet, Massachusetts Health & Hospital Association, August 2017. -More information: MHA Care Act PowerPoint, 8/25/17
OBRA/PASRR Preadmission Screens for Mental Illness- New Administering Agency and Processes This article covers the same content as included in two e-mails recently sent to the Social Service Department. As of September 1, 2017 the University of Massachusetts Medical School (UMMS), as the designee of both MassHealth and the Department of Mental Health (DMH), will assume responsibility for OBRA/PASRR Mental Illness pre-admission screens. The new contact information is: UMass Medical School Please note that the OBRA form, as of now, still has the old Lahey Health Behavioral Services contact info. Please use the contact information above instead. To submit a completed Level II form:
Questions? Contact UMass Medical School via the contacts listed above. Social Service staff can also address questions to Ellen Forman.
MassHealth Loosens PT-1 Locality Restrictions
Effective September 1, 2017 an important amendment (130 CMR 407.411) loosens the MassHealth non-emergency transportation (PT-1) locality restrictions. MassHealth regulations in effect prior to 9/1/17 state that MassHealth “pays for an eligible member to be transported to sources of medical care only within the member's locality, unless otherwise authorized by the MassHealth agency. Locality refers to the town or city in which the member resides and to immediately adjacent communities.” As of 9/1/17, “locality” is now defined more generously as the town or city in which the member resides and the surrounding communities within 25 miles of that town or city. The Customer Web Portal (CWP) has been updated so that when a provider submits a PT-1 form (Provider Request for Transportation) the CWP will calculate the 25 mile radius and will notify the provider of the locality status. If the destination is outside of the member's defined radius, the provider must choose another treating facility within the locality or submit justification for the request. Partners’ Public Payer Patient Access, as always, is in close communication with MassHealth and have requested the MassHealth create a list of towns within 25 miles driving distance from Boston for our reference. Watch this space for updates! -Adapted from 1 Customer Service, Manage Claims and Payment Notice - Monday, 8/14/17, MA Health Care Training Forum. -Thanks to Brooke Alexander, Senior Program Manager, Partners Public Payer Patient Access, for additional information and assistance.
Boston Elder Info Centralized Aging Services Access Point Referral for Boston- Referral Form Available Boston Elder Info runs the centralized referral process for the three Aging Service Access Points (ASAPs) located in Boston: Boston Senior Home Care, Central Boston Elder Services and Ethos. While they still accept telephone referrals, they also have a referral form that includes all of the information they need to direct the referral to the correct agency and convey the patient’s needs. They do prefer you use the form when making multiple referrals. In a recent phone call Boston Elder Info staff said that the completed form may be faxed or e-mailed and that they are registered and familiar with accessing “Send Secure” e-mail sent from Partners entities. See the form: Boston Elder Info referral form. Social Service staff will also find the form on our website under Elder Services (ASAPs). -Thanks to Gabrielle Haseotes for sharing the form!
TAFDC Annual Clothing Allowance Available to Some Not Regularly Eligible for Benefits Each September families receiving assistance from TAFDC receive an additional clothing allowance, currently $250, for each eligible child. These families may even get an additional $50 per child if the legislature overrides the Governor’s veto of a proposed increase in the clothing allowance to $300. The Legislature will begin to take up veto overrides after Labor Day. The following children are NOT eligible- those who:
Families already enrolled in TAFDC should automatically receive the clothing allowance payment for each eligible child at the end of August. Important advocacy tip: some families usually just over-income for TAFDC may qualify! The income limit is slightly increased in September to allow working families to qualify for the clothing allowance. This may in turn enable them to access additional benefits: if families qualify for the clothing allowance, but not cash assistance, they may receive one year of MassHealth benefits and subsidized child care in addition to the clothing allowance. Last year the rules changed to allow those who apply in September or are only eligible for part of the month to receive the full, non-prorated benefit Important Note for those Receiving SNAP Benefits: The clothing allowance benefit is considered income under SNAP program rules; as with other increases in income, the receipt of the clothing allowance can lead to a temporary decrease in SNAP benefits for some families. For more information see: Mass Legal Help or DTA Policy Online.
Children Receiving Certain Aid Should Automatically Get Free School Meals Under the state's Medicaid Direct Certification pilot, all children on MassHealth with family gross income under 133% FPL should be "directly certified" for free school meals. Also eligible are children who get MassHealth automatically with another benefit or DCF care ( Medicaid "referred eligibles"). Non-parental income does not count in determining MassHealth, SSI or Adoption Assistance eligibility. Here are two fliers, one in English and the other in Spanish, which explain the rights of children to qualify for free school meals. (Same text as before, but now on two pages). If you hear of any families who should be getting free school meals for the children in their custody but were told otherwise, please let MLRI know ASAP. Mass Law Reform Institute (MLRI) is receiving reports of errors- children who should have been directly certified, but who are not receiving free meals.They suspect the problem is that the Executive Office of Health and Human Services (EOHHS) Department of Medicaid and the Department of Elementary and Secondary Education (DESE) did an incomplete data exchange that failed to include of all the children on MassHealth who are eligible for free school meals under the state's Medicaid Direct Certification pilot. MLRI has notified DESE and EOHHS of this discrepancy. MLRI thinks the bulk of children not getting processed properly are likely children living with non-parent caregivers - grand parents, aunts, uncles, etc. School Meal Debt/Shaming MLRI would also like to know if you hear of any families whose children are shamed or punished in any way due to an outstanding meal debt from last year. Shaming can include barring the child from extra-curricular activities, not allowing the child to purchase a la carte food, stamping a child's hand or otherwise involving the child in collection of the debt. School meal debt SURVEY, click here: https://goo.gl/forms/RJhcSzR6xdLq003q2 -See the Direct Certification Flyer in English and Spanish -Adapted from Problems Surfacing re Free School Meals for Children living with Relatives; Fliers in English and Spanish, Food SNAP Coalition listserv, on behalf of Patricia Baker, Mass Law Reform Institute, August 29, 2017.
DTA Policy Guidance Qualifies More Low-Income College Students for SNAP DTA released policy guidance this month that qualifies more low-income college students for SNAP benefits. Mass Law Reform Institute (MLRI) has been working closely with DTA over the past six months to figure out policy options to address food insecurity of college students who do not qualify for SNAP because they do not receive Work Study, work 20 hours a week, care for a child or meet the other narrow student rules. See the DTA Online Guide Transmittal 2017-52 and revised our Know Your Rights SNAP College fliers at: https://www.masslegalservices.org/food4students DTA has made changes in three areas: 1. Students with MASSGrant Financial Aid: DTA has issued policy that students whose financial aid package includes the needs-based MASSGrant benefit may be SNAP eligible. DTA has issued this policy because MASSGrant is funded with the TANF block grant. Under federal law, TANF-funded benefits qualify for an exemption under the student rules. Note, the student must meet the other SNAP eligibility rules on household composition, citizenship/immigrant status, financial, etc. According the Department of Higher Education, about 52,000 low income MA students receive a MASSGrant. Some may already be receiving SNAP because they meet the other student exemptions, or ineligible because they live in a household that is over-income for SNAP. But many students may well be SNAP eligible with this policy change! For more on MASSGrant eligibility: http://www.mass.edu/osfa/programs/massgrant.asp 2. Quincy College Students: This past spring, DTA agreed that students who are enrolled at Quincy College can qualify for SNAP on the same basis as other community college students. Quincy College is a municipally-administered 2 year college that receives Perkins funds (this is different from low-interest Perkins loans provided directly to students) and meets the criteria of the SNAP rules. Remember: Any student in a Massachusetts community college may be SNAP eligible – regardless of work, work study or other rules – if they are in a course of study that meets the Perkins Act definition of Career and Technical education program or would likely lead to employment. Most community college and Quincy College courses meet this definition. Both high schools and community colleges receive federal Perkins Act money to boost their career and technical education programs for students. 3. Simplified DTA Student Forms: With MLRI’s recommendations, DTA has revised both forms for colleges to fill out for students seeking SNAP.
Application and Advocacy
-Adapted from More MA Low Income College Students Eligible for SNAP! Major Policy Changes Released TODAY!!, Food SNAP Coalition listserv, on behalf of Pat Baker, August 25.
Cambridge Middle-Income Housing Rental Program Waitlist Lottery Cambridge Community Development Department 's Housing Division is establishing a Middle-Income Rental Program applicant waiting pool for households earning between 80 and 120% of Area Median Income (AMI). Click here for AMI income ranges. The Middle-Income Rental Program apartments will be privately developed, owned, and managed. Households interested in entering the lottery to be added to the Middle-Income Rental Program waiting pool must complete an application and submit it by mail or in person to:
Cambridge Community Development Department To learn more about the Middle-Income Rental Program, visit the program webpage or attend one of the following information sessions:
Wednesday, September 6th Monday, September 11th The Housing Division is accepting applications for a Middle-Income Rental Program applicant waiting pool for affordable apartments. These apartments are designated for households earning between 80 – 120% of Area Median Income (AMI).
-Thanks to Melanie Cohn-Hopwood for sharing this information.
State Halts Admissions at Recovery Centers of America’s Danvers Drug Treatment Center The state shut down admissions at Recovery Centers of America’s inpatient addiction treatment center in Danvers, the Boston Center for Addiction Treatment, this month, citing “concerns regarding patient care and safety.” The Department of Public Health took the step after the death a week earlier of a patient who was being treated at the facility. “Because of these ongoing concerns, we have suspended new admissions to RCA’s Danvers facility until we complete our investigation,” said a Department of Public Health spokeswoman. The patient, a 61-year-old man who officials have not named, is the second patient of the facility to die this year. Nine people have died in licensed substance use treatment programs this year, according to the state, and no facility other than RCA Danvers has reported two deaths. RCA officials could not be immediately reached for comment. The state’s announcement came hours after the Globe and STAT published on their websites a lengthy investigation into evidence of turmoil and shoddy care at RCA’s Danvers and Westminster treatment centers. In addition to the Danvers patient who recently died, another patient died after overdosing at the facility in February. That patient had also sought help at Westminster, where staff complained repeatedly to RCA management and the state that he was not receiving proper care, according to state complaints. The shutdown is effective immediately, according to the state. The Boston Center for Addiction Treatment opened this January and has 72 beds. It is RCA’s largest inpatient facility. Patients who are already in treatment will not be moved. The state has not set timetable for completing its probe. Recovery Centers of America describes itself as the “fastest-growing” addiction treatment provider in the country, offering “five-star,” resort-like accommodations. It has already sunk more than $50 million into buying and renovating its two facilities in Massachusetts: Danvers, which was once Hunt Hospital, and a former country inn in Westminster that opened in October with 48 beds. The company operates three other inpatient facilities and four outpatient facilities in Pennsylvania, New Jersey, Maryland, and Delaware. The Massachusetts facilities have been plagued by concerns of understaffing and inadequate treatment, and staff have complained to the state that they fear they are not able to keep patients safe. Statewide this year, the DPH has investigated nine complaints at treatment centers — and three of those investigations were at RCA properties. Investigators visited Westminster in February and Danvers in May and July, finding that each was understaffed and patients were not properly supervised. RCA has submitted corrective action plans. -See the full Boston Globe article.
State Permanently Closes Westwood Lodge
Just four weeks after declaring it safe for patients, the state has permanently closed the troubled Westwood Lodge psychiatric hospital. The agency’s initial statement to the Globe did not provide details, but one employee said a patient allegedly assaulted another patient last week. Safety lapses occurred despite assurances by the mental health department that it was closely supervising the hospital— and promises by Westwood Lodge executives that the treatment facility had emerged from its recent problems “as a stronger organization.’’ The hospital did not immediately respond to a request for comment. In June, a Boston Globe review found that the seven Massachusetts psychiatric hospitals owned by Arbour Health System, including the 89-bed Westwood Lodge, have repeatedly and sometimes egregiously shortchanged patient care while reaping robust profits. Conditions in the Westwood Lodge children’s unit have been particularly troubling, with children at one point sleeping on bare plastic mattresses in filthy rooms, children injured during fights and by broken glass, and one given the wrong medication for nine days, the Globe reported. The children’s unit has been closed since April 26. The adult units at Westwood Lodge have also been cited for not having enough staff and for not properly monitoring patients. A 32-year-old Lowell man, Michael Bakios, died in his bed two years ago when staff did not check on him every five minutes as required. The oxygen equipment they tried to use to revive him was broken. Admissions to the adult and adolescent units were closed May 12. But on July 31, state mental health regulators decided to give the hospital another in a long series of chances. They said an external monitor had been working with Westwood Lodge for seven weeks and documented improvements, which were confirmed during two inspections. The hospital had filled key leadership positions and hired more doctors and nurses, the state said. Regulators allowed it to gradually begin admitting adult patients. Dania O’Connor, the hospital’s chief executive, told the Globe in an e-mail at the time that Westwood Lodge renovated patient units, strengthened programming, and improved treatment plans. “We are confident that these improvements will be positively received by patients and their families, as well as by our dedicated staff,’’ she said. “The Department of Mental Health made the decision to close the Westwood Lodge effective August 25, 2017, due to issues of patient safety, quality of care, and the facility’s failure to comply with DMH requirements,’’ spokeswoman Daniela Trammell said in an e-mail to the Globe. These issues occurred despite the presence of an external monitor on site at the hospital two or three days a week. Westwood Lodge shares a joint license with two other Arbour facilities, Pembroke Hospital and Lowell Treatment Center. The mental health department said it would continue to work with Arbour to continue operations of these two facilities. Arbour has long defended its record, saying it cares for some of the state’s most challenging patients, many of whom other hospitals turn away. Arbour is the largest provider of psychiatric care in the state, and is owned by Universal Health Services, the biggest psychiatric hospital company in the country. The mental health department has also defended its decision to give the hospitals numerous chances to improve. Between January 2015 and last week, the state has inspected the Arbour facilities on 91 occasions, the agency said. That compares to 116 inspections for the state’s 60 other psychiatric hospitals. -See the full Boston Globe article.
Service at the T’s Ride Improving, but Still Lagging Service on the MBTA’s door-to-door service for riders with disabilities has improved somewhat after a spike this spring in missed trips, long wait times, and customer complaints. The company hired by the T to handle scheduling and dispatch services has made a number of changes in its Medford office — such as firing its local general manager — in response to mounting customer complaints and fines from the T. But even with the recent improvements, the number of missed trips under Global Contact Services is still higher than under the previous operators that managed scheduling for The Ride. The T shifted dispatching services in 2016 from the three longstanding regional operators of The Ride to North Carolina-based Global Contact. The $38.5 million contract runs through 2020, with options for the T to extend it. Global Contact is assuming control over dispatching the three regional Ride providers in stages through much of this year. But within just a few months of operation under Global Contact, service on The Ride began to deteriorate, with on-time performance dropping to as low as 85 percent, and drivers failing to pick up passengers 2 percent of the time some weeks. By June the T had levied $100,000 in fines against Global Contact for missing performance targets. Since then, service has improved, with on-time performance now above the T’s goal of 90 percent, and average wait times for callers under the target of 90 seconds every week. Over the past three weeks, the average call wait time has been below 30 seconds, after topping out at 3.5 minutes in late May. And while the rate of missed trips has also improved, the performance for July, ranging from 0.4 to 0.9 percent, is still above the rate of about 0.3 percent before Global Contact took over. Global Contact has so far begun dispatching and scheduling rides for two of the three Ride service providers, with the third and final operator coming under its purview later this year. Ben Schutzman, the MBTA’s director of transportation innovation, said the agency has also hired management consulting firm Accenture to analyze the call center problems and suggest improvements. He said Global Contact will not be allowed to take over dispatching for the third provider, Veterans Taxi, which services the metro-west area, until those recommendations are implemented. -See the full Boston Globe article.
Can I Keep the Last Social Security Benefit Payment When a Beneficiary Dies? When a Social Security beneficiary dies it may be unclear to the family if they can keep a final benefits check. Social Security retirement, disability and survivors benefits are always paid the following month. Social Security pays your benefit after you have lived throughout the month. Being eligible throughout the month also applies to the month of death of a Social Security beneficiary. To be eligible for the payment, the person must have lived all month long to receive the payment that comes the following month. That includes throughout the entire last day of the month.
Your survivor however may be eligible for a payment for the last month and should contact Social Security at 1-800-772-1213. For information about applying for survivors benefits, visit their website at www.socialsecurity.gov/planners/survivors/howtoapply.html.No Please note that the payment schedule discussed above does NOT apply to Supplemental Security Income (SSI). SSI benefits are not paid in the month that you first apply. After the month of application or the month in which you first become eligible and meet SSA requirements, SSI benefits are normally paid on the first day of the month they are due. For example, benefits for August are paid August 1. (Source: https://www.ssa.gov/OP_Home/handbook/handbook.21/handbook-2104.html)
Income Exempt from Debt-Collection State and federal law prohibits income from some public benefits, and income below certain thresholds, from being used toward debt-collection orders, but a nonprofit group that provides legal aid to the poor says local district courts have flaunted those laws and regulations. Income sources that are completely protected include SSI benefits, Social Security retirement, survivors and disability (SSDI), Unemployment Compensation, EAEDC, TAFDC, Workers Compensation, certain Veteran’s benefits, certain retirement funds (more exempted income and detailed information at http://www.masslegalhelp.org/consumer/debt/court/stop-creditors). A portion of earned income is also protected. If income is low enough all earnings may be protected (see http://www.masslegalhelp.org/consumer/debt/court/stop-creditors for more detail). Northeast Legal Aid is now suing Lowell District Court and several other district courts in the region as they ask the Supreme Judicial Court to suspend all debt-collection payment orders from district courts in northeastern Massachusetts. "The clerks are supposed to make sure that no agreement between a creditor and debtor is made with those funds," said George Weber, executive director of Northeast Legal Aid. Northeast Legal Aid found over 1,000 other examples where clerks accepted payment agreements based on outdated forms that misled debtors about how much of their income is exempt from court orders, according to the lawsuit. Weber said many of those with exempted income are elderly or disabled. Interns the group sent into 15 small-claims sessions around the region reported that clerks routinely failed to ask about the source of debtors' income before approving agreements, even though such inquires are required by regulations. Weber said the abuses could be far more widespread, but that his organization filed the lawsuit immediately after doing research in the area it serves in the northeast part of the state. The lawsuit asks the SJC to suspend all payment orders in northeastern courts until clerks determine that such orders are not based on exempt income; to order the courts to vacate any orders based on exempt income; to hire an independent auditor review all small-claims cases; and to set up an independent monitor in the courts for at least two years to ensure that state laws are being followed. -See the full Lowell Sun article.
Boston Addiction Support Walk-In Clinic Increases Hours Boston Public Health Commission’s Providing Access to Addictions Treatment, Hope, and Support (PAATHS) walk-in clinic has added weekday and weekend hours. PAATHS provides information and access to substance use treatment services to anyone in the Greater Boston area. They are now open 7:30 AM – 6 PM on weekdays and 8 AM – 3 PM weekends. Services are provided on a first come, first served basis. PAATHS cannot guarantee same day placement in a treatment facility or program. If you are referring a patient, please call ahead of time to 855-494-4057 or 617-534-5554. For more information: http://www.bphc.org/whatwedo/Recovery-Services/paaths-connect-to-services/Pages/paaths.aspx -Thank you to Lindsey Krenzel and Melanie Cohn-Hopwood for sharing this resource update.
Next Step- Support for Teens and Young Adults with Life-Threatening Illnesses Next Step serves teens and young adults with life-threatening illnesses, including cancer, HIV, sickle cell disease, and rare genetic diseases. Their year-round programs are free of charge to participants, and take place at their facility in the Central Square neighborhood of Cambridge, MA, New England and across the country in partnership with local hospitals and service organizations. Programs include “camperences”, retreats, workshops, music therapy and more. Teen and young adult participants co-design curricula, resulting in programs that speak to young people in their own language and aimed at keeping them engaged and learning during their transition to adulthood. Programs are intentionally kept small, and many meet multiple times throughout the year, to enable staff to give youth the in-depth, individualized attention they need and deserve. For more information or to refer please contact Kepler Jeudy, program director, at kepler@nextstepnet.org or at 617.864.2921. We look forward to hearing from you! -Thanks to Jackie Cardarelli for sharing this resource.
EBT Card Holders Now Eligible for Free or Reduced Admissions at 100+ Museums and Cultural Venues In an ambitious attempt to expand access to museums and other cultural institutions, the state has rolled out a program to provide low-income residents with free or reduced admission to more than 100 venues across Massachusetts. The discounts will be available to anyone with an Electronic Benefit Transfer card, which is used primarily for the state’s food-assistance program. More than 758,000 people get food aid under the Supplemental Nutrition Assistance Program. A number of venues, including the Children’s Museum and the Museum of Fine Arts, have offered discount admissions to EBT cardholders for several years. But the new program marks a major expansion, bolstered by institutions such as the USS Constitution Museum, the Edward M. Kennedy Institute for the United States Senate, and the Boston Symphony Orchestra. It is the most comprehensive effort of its kind nationwide to bridge the income inequality gap in the arts, according to the Massachusetts Cultural Council, which developed the EBT Card to Culture in partnership with the state’s Department of Transitional Assistance. “Some parents who are using the card are now telling us they have never been to a museum in their lives,” said Carole Charnow, the Children’s Museum’s chief executive. “For a lot of people with long-term unemployment, it’s their lifeline, because they have no way to entertain their children.” At the aquarium, EBT cardholders will be able to pay $2 per person for up to four people, compared with the regular $27.95 admission for adults and $18.95 for children. The state Department of Transitional Assistance will have a comprehensive list online of participating institutions. -See the full Boston Globe article.
Gateway Arts- Helps Young People with Disabilities Transition from School to Work in the Arts Gateway Arts prepares young people with disabilities to transition successfully from school to work using age appropriate, professional arts-based activities considering individual needs, strengths and interests. This service is also available for talented adults turning 22 with appropriate public or private funding. Disabilities include developmental and psychiatric, including cerebral palsy, spinal cord injury, visual impairment, hearing impairment, head injury, Williams Syndrome, and spectrum disorders including autism and Asperger’s syndrome. Gateway artists spend their time creating artwork and craft items that can be exhibited and sold. The work at Gateway is designed to prepare young adults with disabilities for further employment, education, and independence. The pre-vocational skills and enhanced self-esteem help enable people to transition successfully into various fields of interest or supported employment or can lead to a career in the arts. Artists come to the studio where they are encouraged to work on their projects with facilitation as necessary. Gateway provides high quality art materials, as well as a staff of professionally trained artists and educators who are always available for suggestions and gentle encouragement. Gateway also plans offsite field trips and outings for artistic inspiration and community participation. Gateway provides a community of other young adults and practicing artists of all ages in a supportive, diversified community where participants make valuable connections and are there to help each other through the challenges that can accompany transition and change. This support takes the form of interactive learning, feedback, conversation, and friendships that help build confidence and real world skills. Read the Transitional Planning for Young Adults Brochure to learn more. Requirements for Admission Be a minimum of 16 years old, still in school or post graduation, looking for a community transition experience and exploring art as a career option. Some interest in art and the ability to work within a shared studio environment with other young artists. Previous training not required. How to Apply
Contact Ted Lampe The program encourages applicants to contact a transitional planner at their high school or the Department of Developmental Services for additional information.
Gateway Arts - More information at: https://www.gatewayarts.org/services/transitional-planning/
New Updated Version of the MassHealth DME/OXY Payment & Coverage Guideline Tool The MassHealth Durable Medical Equipment (DME) and Oxygen Payment and Coverage Guidelines Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the applicable Tool, go to http://www.mass.gov/eohhs/gov/laws-regs/masshealth/, click on "Provider Library" and then on "MassHealth Payment and Coverage Guideline Tools". For more information about this notice or any previous notices please visit www.mass.gov/masshealth/newmmisnotices.
Only Half of Eligible Beneficiaries are Receiving Help with Part B Costs
A new report for the Medicaid and CHIP Payment and Access Commission (MACPAC) examines the enrollment of likely eligible Medicare beneficiaries in Medicaid programs that assist with Medicare Part B premiums and cost-sharing, known as the Medicaid Savings Programs (MSPs). Using the most recently available data (2009 and 2010), the analysis shows that participation in the MSPs remains low: only 53% for the Qualified Medicare Beneficiary (QMB) program; 32% for the Specified Low-Income Medicare Beneficiary (SLMB) program; and 15% for the Qualifying Individual (QI) program. The analysis seeks to understand why low enrollment persists by comparing characteristics of MSP enrollees with those eligible but not enrolled. -See the full Medicare Rights Center blog post.
Medicare Reminder – Emergency Services Coverage Medicare covers emergency room services everywhere in the United States. You will pay a copayment for these services, which are considered outpatient hospital treatment. If you are admitted to the hospital, you or your supplemental insurance must pay for the Part A deductible and coinsurance. - Medicare Watch, Volume 8, Issue 27, August 24, 2017.
Medicare Reminder- Understanding Extra Help Notices There are several changes that can happen each year for people with Extra Help, a federal program that helps pay Medicare prescription drug costs, before and during Fall Open Enrollment. If a change is being made to your Extra Help coverage, you will be mailed a notice sometime in September, October, or November. Look out for the colors and titles of these notices to find out if you need to take action to change or keep your Extra Help benefits. If you receive an orange notice, you do not need to take action. This is the “Change in Extra Help Copayments” Notice, and you may receive it sometime in October. This notice explains if the Extra Help copays will change in 2018. Copays usually change a small amount each year. Read this notice to learn how much you will pay for your covered drugs in 2018, and save it for your records. If you receive a blue notice, you might need to take action. There are two kinds of blue notices, and they are both called Reassignment Notices. The first kind of Reassignment Notice is sent out in October to people whose Medicare Advantage (MA) plans or Part D drug plans are leaving the Medicare program. If you receive this notice, it means that you will be reassigned to a new MA or Part D plan in 2018. If you want to choose your own plan, you will have to choose it by December 31, 2017. If you do not take action, you will be automatically enrolled in a different plan that may or may not fit your prescription drug needs. The second kind of blue Reassignment Notice is sent in October to people whose MA or Part D plan premiums have risen above the Extra Help benchmark (the maximum premium amount that Extra Help will cover). If you receive this notice, it means you will be assigned to a new plan in 2018. If you want to choose your plan, you should do so before December 31, 2017. Otherwise, you will be automatically enrolled in a new plan. If you receive a gray notice, you should be prepared to take action, because it means that you could be losing Extra Help or paying more in the coming year. There are also two types of gray notice. The first kind of gray notice is a “Loss of Deemed Status” Notice. This notice is sent in September to people who will no longer qualify to get Extra Help in 2018. If you get this notice, but you think it is a mistake (because your income hasn’t changed and/or you’re still below the income and asset limits for Extra Help), you should reapply for Extra Help right away so you don’t lose coverage in 2018. You can apply by calling the Social Security Administration at 1-800-772-1213, visiting your local Social Security office, or applying online here. The second kind of gray notice is the “Low-Income Subsidy Choosers” Notice. You will receive this in November if you chose your current drug plan (instead of being automatically enrolled in one), and your plan premium is increasing above the Extra Help benchmark amount in the coming year. If you receive this notice, it means that you have to actively change your plan to one with a lower premium. If you do not actively switch to a plan with a premium below the Extra Help benchmark, you will pay part of the premium (the difference between the premium amount and the benchmark amount) in 2018. - From What do the Extra Help notices mean? Dear Marci e-mail, Medicare Rights Center, August 21, 2017.
Using a Prepaid Funeral Contract to Spend Down Assets for Medicaid No one wants to think about his or her death, but a little preparation in the form of a prepaid funeral contract can be useful. In addition to helping your family after your death, a prepaid funeral contract can be a good way to spend down assets in order to qualify for Medicaid. Learn more: Using a Prepaid Funeral Contract to Spend Down Assets for Medicaid, Elder Law Answers.
Nationwide Class Certified in Medicare “Observation Status” Case Eighty-four-year-old Nancy Niemi of North Carolina was hospitalized for 39 days earlier this year after her doctor sent her to the emergency room. It took weeks to stabilize her blood pressure and she experienced serious complications. But unbelievably, Ms. Niemi was categorized as an outpatient on “observation status” for her entire hospitalization, and she therefore lacked the three-day inpatient stay Medicare requires for coverage of her subsequent, very expensive care at a nursing home. Ms. Niemi’s son tried to help her challenge her lengthy placement on observation status, but Medicare does not allow beneficiaries to appeal this issue. She still owes thousands of dollars to the nursing facility. However, due to the federal court decision issued July 31, 2017, she is now a member of a nationwide class of hospital patients who may gain the right to appeal their placement on observation status. In Alexander v. Price Judge Michael P. Shea of U.S. District Court in Connecticut, certified a class composed of all Medicare beneficiaries who, since January 1, 2009, have received or will have received “observation services” as an outpatient during a hospitalization. The late Martha Leyanna of Delaware, for example, one of the named plaintiffs in the case, had to pay thousands of dollars for nursing facility care after being hospitalized for six days on observation status. “My mother was treated just like she was inpatient,” her daughter Mary Smith explained, “but she was never allowed to try to prove her case to Medicare. It was very unfair.” Class members are likely to number in the hundreds of thousands. The court cited a 2012 study by researchers at Brown University that identified 918,180 Medicare beneficiaries who experienced observation stays in 2009 alone. In addition to lacking coverage for very costly nursing home care, patients on observation status can also face increased costs for drugs taken at the hospital and copayments for hospital services, as noted by a recent report from the Department of Health and Human Services’ Office of the Inspector General. -Adapted from http://www.medicareadvocacy.org/court-certifies-nationwide-class-in-observation-status-case/
Patients Pressured to Take Brand-Name Drugs at Higher Out-of-Pocket Cost It’s standard advice for consumers: If you are prescribed a medicine, always ask if there is a cheaper generic. Nathan Taylor, a 3-D animator who lives outside Houston, has tried to do that with all his medications. But when he fills his monthly prescription for Adderall XR to treat his attention-deficit disorder, his insurance company refuses to cover the generic. Instead, he must make a co-payment of $90 a month for the brand-name version. By comparison, he pays $10 or less each month for the five generic medications he also takes. “It just befuddles me that they would do that,” said Mr. Taylor, 41. Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics. The practice is not easy to track, and has been going on sporadically for years. But several clues suggest it is becoming more common. Shire, the maker of Adderall XR, and some other brand-name drug manufacturers are no longer content to allow sales of their products to plummet when generic competitors arrive on the market. Instead, they are negotiating deals with insurers and pharmacy benefit managers to give priority to their versions. Consumers are given no details about these deals. A few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark. Pharmacists say they are noticing the trend, too, and it takes time to understand the denied claim and pursue a remedy, including sometimes calling the doctor. While favorable treatment for a brand-name drug doesn’t happen all the time, it is startling when it does, said Robert Frankil, president of Sellersville Pharmacy Inc. in Pennsylvania, which owns two pharmacies. “There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.” -See the full New York Times article.
State Sees Boom in Number of Psychiatric Beds, But Staffing is Problematic As psychiatric patients struggle to get treatment, some of them waiting for days in emergency rooms, health care companies have seen an opportunity: Three gleaming new psychiatric hospitals have gone up in Massachusetts since 2015, and two more are in the works. But it’s turning out to be harder than expected to fill them with patients. At least one hospital has been forced to limit patient admissions because it hasn’t been able to recruit psychiatrists. Further, state mental health leaders and hospital owners are grappling with the fundamental question of whether these new facilities will be willing to treat the most challenging patients. TaraVista Behavioral Health Center in Devens, a new hospital built by Concord psychologist Michael Krupa and private investors, has opened just 30 of its 108 licensed beds since November. Krupa said he is struggling to hire doctors, and has made do with two temporary psychiatrists, despite increasing salaries 20 percent and offering signing bonuses. Psychiatric hospitals are supposed to stabilize patients who are suicidal or at risk of harming others, usually with medication adjustments, but are not meant to provide long term treatment. Many patients in crisis end up going to an emergency room, where they wait for a hospital bed to become available. Mentally ill patients with complex needs tend to wait the longest in emergency rooms because psychiatric hospitals often don’t have enough staff, or the appropriately trained staff, to care for them. The Department of Mental Health is pushing hospitals to take these hard-to-place patients, who include children and those with intellectual disabilities, a history of assault, significant medical problems, or addiction. The mental health department requires hospitals to describe in their license application how they will “facilitate” admissions for these especially needy patients, officials said. But they stopped short of saying these services are required, and the agency is drafting new regulations. The department is working “to establish an enforceable expectation that individuals who require inpatient hospital level of care will have access to the services they need,’’ a department spokeswoman said in an e-mail. David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems said hospitals want to accept needier patients, but require better reimbursement rates from insurers and government health programs to be able to do so. -See the full Boston Globe article.
Caregiving is Hard Enough. Isolation Can Make it Unbearable. Those who work with caregivers know the phenomenon of caregiver isolationwell, especially when the cared-for person has dementia, a particularly arduous responsibility. “Caregiving is done with a lot of love and affection, but there’s a lot of loss involved,” said Carey Wexler Sherman, a gerontologist at the University of Michigan Institute for Social Research. “People talk about friends disappearing, about even family members not wanting to be involved. It’s a lonely business.” Sometimes, caregivers isolate themselves. Barbara Moscowitz, senior geriatric social worker at Massachusetts General Hospital, hears clients lament that with a loved one whose dementia-related behavior can be startling, venturing out in public creates more apprehension than pleasure. “They say, ‘I’m exhausted trying to explain to people why she’s doing what she’s doing, why they shouldn’t be angry or afraid,’” Ms. Moscowitz said. “It’s just easier to stay home.” Yet a habit of avoiding others — or watching them avoid you — collides with a growing body of research showing how damaging isolation and loneliness can be. They are associated with a host of ills, including heart disease and stroke. Among older people, isolation is linked to depression, even higher mortality. Lonely old people, Dutch researchers have found, are more apt to develop dementia. We’ve long thought of these factors as dangers for the people being cared for. But they also imperil caregivers, who are often older adults as well. We know something about how to help caregivers feel less alone. Researchers have shown that even modest-sounding interventions can reduce their sense of isolation and improve their mental and physical health.
Mary Mittelman, director of the Alzheimer’s Disease and Related Dementias Family Support Program at New York University, has been conducting such studies for years. “The support is what leads to less stress, less depression, better health and delayed nursing-home admissions,” Dr. Mittelman said. Interestingly, her team has found that “instrumental support,” in which others actually help with tasks, has less impact than emotional support. “Having someone outside who is paying attention and who cares is more important,” she said. On other fronts, we’re seeing more efforts to provide convivial social and cultural events for both people with dementia and their caregivers: Memory Cafes, museum programs, choruses. The Dementia Friendly America campaign aims to make whole communities — including police forces, churches, restaurants and hair salons — more knowledgeable and accommodating. Individuals can also play a role. It’s too easy to let caregiving friends slip off our radar with a general call-if-you-need-anything. Though tangible help counts — and let’s acknowledge that an aging country can’t rely solely on families, friends and volunteers to provide everything dependent elders need, however well supported they are — so do regular texts, calls or visits. They help keep caregivers from feeling invisible and forgotten. -See the full New York Times article.
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