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MGH Community News |
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MGH Community News |
| September 2017 | Volume 21 • Issue 9 |
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. |
Trump Administration Drastically Cuts ACA Enrollment Period, Outreach and Assistance ACA Open Enrollment is from November 1 - December 15, 2017. Clarification: The MA Open Enrollment will run through January 23, 2018. The 12/5 closing date applies to the federal exchanges and some states. States who run their own exchanges have discretion. (Here's NPR's list of the other 10 states plus the District of Columbia that run their own ACA sites and marketplaces.) Learn more.The Trump administration has come under attack from critics who say that it is intentionally undermining the Affordable Care Act through regulatory actions. It cut the enrollment period from three months to 6 weeks duration, slashed money for advertising by 90% and sliced the budget for navigators to help people shop for plans. It also recently announced that it plans to shut down the federal health insurance exchange for 12 hours during all but one Sunday in the upcoming Obamacare open enrollment season. In an e-mailed statement, Liz Hagan, Associate Director of Coverage Initiatives for Families USA said “We know from the past four open enrollment periods that in-person assistance is critical to helping consumers getting health insurance. Without funding for outreach and enrollment assistance, people across the country, and particularly communities of color, harder to reach and the most vulnerable, will struggle to get the coverage and care they need.” Not only do these actions to suppress marketplace enrollment have the potential to reduce the number of people who gain coverage, they could lead also to less-balanced risk pools and higher costs for consumers. Administration Actions to Undermine Enrollment Part of a Larger Pattern Recent activities build on an already clear pattern by the Trump Administration trying to undercut enrollment as a way to prove the ACA is “failing” despite evidence to the contrary. Here are a few recent examples of what the Trump Administration has been doing:
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Outreach, education, and enrollment efforts all contribute to successful enrollment. We’ve learned from past open enrollment periods that consumers who receive in-person assistance are more than twice as likely to successfully enroll as those who tried enrolling online on their own.
Get the word out. Publicize the fact that open enrollment is taking place from November 1 - December 15.
SNAP Cost of Living Adjustments - Good and Bad News Each October, USDA announces changes in the SNAP "cost of living adjustment" or COLA. Typically one thinks of COLAs as increases, but sometimes - unfortunately - the SNAP benefits decrease. Here's a link to the USDA Food and Nutrition Service FFY2018 COLA guidance. Starting October 1, 2017 SNAP benefit levels will be REDUCED. The minimum benefit for one person is decreasing from $16 to $15/month. The maximum benefit for one person is decreasing from $194 to $192/month. This will largely impact those with no income who receive the maximum benefit amount and elderly/disabled households who receive the minimum benefit amount. On the positive side, the individual standard deduction from income and the “shelter deduction cap” will INCREASE, so clients with such expenses, not currently receiving the minimum or maximum benefit for their household size, may see an increase in their SNAP benefits. These changes are likely to cause confusion because recipients’ income has not changed. DTA was to mail notices starting September 24 for those households impacted by the change, so patients may bring these letters in for explanation. What SNAP advocates need to know:
Any household getting the $15 minimum, or less than the maximum benefit, is always an opportunity to review the SNAP math for deductions, especially the medical expense deduction available for elders (age 60+) and persons with disabilities. This flyer briefly explains the changes and encourages recipients to report expenses that may increase their benefits: COLA Flyer & Maximize Your Benefits -Adapted from SNAP Policy Updates: Oct 1st SNAP COLA changes; HIP Update; Discount Museum/Arts Passes for EBT households, SNAP Coalition listserv on behalf of Patricia Baker, Mass Law Reform Institute, September 05, 2017.
OBRA/PASRR Preadmission Screens for Mental Illness- New Information Please note this article contains new information since previous departmental e-mails. As reported last month (OBRA/PASRR Preadmission Screens for Mental Illness- New Administering Agency and Processes), 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), has assumed responsibility for OBRA/PASRR Mental Illness pre-admission screens. We’ve received new guidance this month about the “recent treatment” questions, that if negative can trigger an exemption, and “approvals” for the completed Level II screens. Recent Treatment Questions Expanded – More Level II Screens Likely A patient with a mental health diagnosis may be exempt from requiring a Level II screen if they have NOT required recent treatment or intervention. To request an exemption letter we have long submitted a “recent treatment” screening form. If all of the screening/recent treatment questions are negative, the patient should be exempt and UMMS will issue an exemption letter. UMMS has added additional questions to this screening process. Meaning that we are more likely to answer “yes” to some questions and those patients will not be exempt; in other words more patients are likely to require Level II screens. The first 5 recent treatment/intervention questions remain the same:
1. One or more psychiatric hospitalizations Additional new intervention questions:
Here is the current revised Screening form. Guidance- What is an Intervention? UMMS has said they will offer training sometime in late fall. In the meantime they have shared this limited guidance on these new questions. An “intervention” means that one requires or required a community-based support program to remain safe and stable in the community. For example, a substance abuse intervention might include a stay in drug/alcohol rehab, partial programs, Methadone clinic, etc. While attendance at self-help programs such as AA would not be considered an intervention, i.e. would not need to say “yes” if the person is attending AA. Level II – UMMS Will Confirm They are Complete, But Won’t Issue Formal Approval Initially we were informed that as a delegated hospital (who complete our own Level II screens) once we submit the Level II form UMMS will call us with approval to transfer the patient. They have since clarified that unlike the process under Lahey Health Behavioral Services, they will not issue a formal approval on Level II screens they do not complete. They will confirm that it is complete (signed and includes a determination) then will contact MGH to confirm receipt. We should send the completed form to the nursing facility as part of the discharge paperwork. Please contact Ellen Forman with any questions about this, particularly if this leads to discharge delay. Contact Information on the Level II Screen Please note that we have received permission to edit the Level II form to include the UMMS contact information. The form on the website now has the correct contact information (though the determination page still bears the Lahey Health Behavioral Services letterhead). UMass Medical School Contact Information -Thanks to Eva Regel for bringing these changes to our attention and ongoing trouble-shooting and strategizing, and to Laurie Huber for serving as a liaison to UMMS.
Trump Ends DACA- Those Expiring Before March 5, 2018 Can Renew by October 5 The Trump administration this month formally announced the end of DACA -- a program that had protected from deportation nearly 800,000 undocumented immigrants brought to the US as children.
The Department of Homeland Security has stopped processing any new applications and has formally rescinded the Obama administration policy. But the agency also announced a plan to continue renewing permits for anyone whose status expires in the next six months, giving Congress time to act before any currently protected individuals lose their ability to work, study and live without fear in the US.
DACA recipients, whether or not allowed to renew, are encouraged to consult a knowledgeable immigration attorney to investigate any legal remedies available to them. DACA Renewal Legal Clinic Greater Boston Legal Services will hold a final walk-in clinic for DACA renewals on Monday October 2, 2:30- 7:00 pm, at their 197 Friend Street, Boston, Massachusetts location for DACA renewals for current DACA recipients whose employment cards expire prior to March 5, 2018. Applicants should bring: copies of work permit (front and back), copy of Social Security card, initial DACA application, 2 Passport photos, list of addresses for past two years, estimates of annual income, expenses, and assets (for I-765W), copies of ID’s, copies of all the evidence submitted as part of initial DACA application, advance parole travel info, dates of travel and a copy of advance parole document if any, and the $495 Renewal Fee. For More Information The following are available in languages as indicated on the National Immigrant Law Center (NILC) website. DACA Under the Trump Administration
-Adapted from https://www.nilc.org/issues/daca/top-5-things-to-know-about-daca-ending/ and Trump Ends DACA – Homeland Security to Renew for those Expiring in the Next Six Months, CNN Breaking News, September 05, 2017.
Trump Administration Revises Travel Ban to Expand Beyond Muslim-Majority Countries The Trump administration updated its travel ban just hours before it was set to expire. In a proclamation signed by President Trump, the travel restrictions now include eight countries, a couple of which are not majority-Muslim, as had been the case with all the nations in the original ban. Five countries in the previous ban remain under restriction: Iran, Libya, Syria, Yemen and Somalia. Chad, North Korea and Venezuela have been added. The latter two are the first nations included in a version of the travel ban that do not have majority-Muslim populations, which has been a key point in litigation challenging the ban as discriminatory based on religion. Sudan has been dropped from the order. Restrictions for Somalia will be relaxed for non-immigrant visitors, and restrictions for Iran will be relaxed for students and other exchange visitors. The new restrictions on Chad and North Korea are a broad ban on nationals from those countries entering the U.S. For Venezuela, restrictions apply to government officials and their immediate family. These changes are set to take effect on Oct. 18, though the restrictions on Sudan will be lifted immediately, as a result of security baselines defined by the administration.
There are some exceptions for nationals from the eight countries who have "bona fide" connections to the U.S., though narrower than what was ordered by the Supreme Court in its temporary ruling on the travel ban. The high court will hear arguments on the merits of the travel ban on Oct. 10. -See the full NPR story. More Information: Muslim Ban 3.0 Fact Sheet, Penn State Law Center for Immigrants' Rights Clinic, Muslim Advocates, and American-Arab Anti-Discrimination Committee, September 25, 2017.
ICE Raids Specifically Target Sanctuary Communities Fifty immigrants across the state were among nearly 500 nationwide arrested for federal immigration violations in an operation that targeted so-called sanctuary cities and, in the case of Massachusetts, a state that had not fallen in line with President Trump’s aggressive deportation policies. In a statement, Immigration and Customs Enforcement, or ICE, said its four-day “Safe City” operation, which ended Wednesday, was “focused on cities and regions where ICE deportation officers are denied access to jails and prisons to interview suspected immigration violators or jurisdictions where ICE detainers are not honored.” About two-thirds of the immigrants arrested nationwide are wanted on criminal charges, ICE said. According to figures provided by ICE, 30 of those arrested in Massachusetts had criminal records, and the other 20 did not. This operation was distinctive in that “this is focused on areas that have . . . self-proclaimed they are not going to cooperate with ICE.” said Shawn Neudauer, a spokesman for ICE Of the 498 immigrants arrested in the operation, 317 had been convicted of crimes, with the largest number — 86 —having convictions for driving under the influence, according to a statement from ICE. Eighteen of those arrested are alleged gang members or gang affiliates, and 104 have been previously deported. Eva Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, said the federal government is engaged in “very robust” but indiscriminate enforcement of immigration laws. This administration’s approach is different, she said, from the policy under former president Barack Obama, in which violent criminals such as rapists and murderers were given priority for arrest and deportation. “It’s a zero-tolerance policy, with no priorities as to who is dangerous and who isn’t,” Millona said. “I think we need to prioritize and we need to be realistic about who really poses a danger to the community. It needs to be a smart and effective enforcement . . . and it needs to be done in a way that really keeps us all safe.” Millona said even those seeking religious or political asylum, who fear for their safety in their countries of origin, can wind up arrested and deported alongside dangerous criminals if their asylum petitions are denied. Young immigrants in the Deferred Action for Childhood Arrivals program, which forestalls deportation for some who were brought to the United States as children, were not targeted, according to ICE. Nationwide, 181 of those arrested in the sweep were classified as “noncriminal.” Those who had been previously deported will likely be removed from the country again, Neudauer said, while the others arrested will be sent to immigration court. “Not every arrest leads to a deportation,” he said. -See the full Boston Globe article.
Casper Funeral Home Accused of Storing Bodies in Unlicensed Southie Garage Channel 5’s “5 Investigates” team has discovered that Casper Funeral Home and Cremation Services had been storing bodies in a garage that is an unlicensed storage facility for the dead. According to documents obtained by 5 Investigates, during a recent surprise state inspection an investigator found two bodies being processed in the unlicensed space. Twelve others were stashed in a refrigerator and there are no sprinklers or drains. The garage, which sits around the corner from the funeral home, was hot and cluttered. State regulators have put Casper on notice, threatening to take action for what they say is happening inside the Tudor Street building. State investigators say during an inspection, Casper's funeral director told them that the actual funeral home was their only facility and made no mention of that garage. 5 Investigates made numerous calls to Casper and the funeral home’s lawyer for comment, but calls weren't returned. -See the full 5 Investigates story. -Thanks to Rebecca Murphy for forwarding this information.
The Ride is Still Having Service Problems Despite showing some improvement during the summer, the company hired by the MBTA to streamline service for The Ride is still struggling to provide on-time trips for passengers with disabilities. MBTA officials said they would, for a second time, postpone Global Contact Services taking over scheduling and dispatching for about one-third of daily The Ride passengers. The North Carolina company received a $38.5 million contract in 2016 to take over scheduling from the three transportation companies that also provide the van and taxi rides for riders with disabilities, but has been unable to get its on-time service and other performance metrics to consistent, acceptable levels to add the new trips. Global Contact has already taken over dispatching from two vendors that serve about two-thirds of The Ride passengers, but the Oct. 1 scheduled handover of the final subset of passengers is now delayed at least one month. Those customers, largely in the Metrowest area, will continue to book rides with Veterans Taxi in Waltham. Service did improve some over the summer as Global Contact hired additional staff and began working more closely with T officials to address issues. But its performance has dropped off again in September, as wait times on dispatch calls have sometimes exceeded the T’s 90-second goal, and the company did not meet a goal of 90 percent on-time performance during the week of Sept. 14. MBTA board chairman Joseph Aiello said the delay is a “sound decision” to minimize problems for passengers, but said there have been “disturbing signs” with the Global Contact contract. He called on officials to closely review how and why the new system had run into problems. -See the full Boston Globe article.
DTA Clients with Security Concerns Can Block DTA Online and Automated Systems The Department of Transitional Assistance (DTA) cannot release any case information to a 3rd party unless they have permission to do so from the DTA client. However, in some situations a DTA client may be concerned about an abuser or identity thief getting access to their confidential case information--including their new address or phone number. What has changed? Over the past few years DTA has created new ways for clients to get case information without going to a local DTA office or talking to a DTA worker. Currently, DTA clients (and those authorized to talk with DTA) can get case information from three places:
These services can be accessed with limited information, including Social Security Number and year of birth. Clients who may not want the Heightened Level of Security may still worry about others who have their SSN and year of birth gaining access to confidential information - including phone number and address. In response to requests from advocates, DTA has developed a protocol to block access to these 3 services for clients concerned that an unauthorized person has their SSN and year of birth. This privacy block is an important protection for clients worried about an unauthorized person accessing personal information. This block is also important because it is less restrictive than the Heightened Level of Security- clients who sign up for the block do NOT need to go in person to a local DTA office to discuss their case. Clients concerned about security can choose which option they want. -From SNAP Alert: New protections for DTA clients concerned about security, Food SNAP Coalition listserv, on behalf of Victoria Negus, Mass Law Reform Institute, September 07, 2017. Additional informationon the DTA Online Guide 2017-81.
Humane Care Given a Place at Bridgewater State Hospital The Massachusetts prison for men with a mental illness has long been known as a rough place where guards often strapped patients down or locked them in isolation cells for misbehavior — and where some patients met gruesome deaths. It was an appalling, often inhumane place, an embarrassment to the state that seemed — to the mentally ill and their advocates — like it would never change. But it has. In April, a private firm hired by the Baker administration replaced almost all the guards at Bridgewater State Hospital with a specially trained security force, along with psychiatrists and other clinicians equipped to provide more humane methods of handling distressed patients. Governor Charlie Baker called it “a culture change.” Five months in, the results are remarkable, beyond the imagining of mental health advocates. Since Correct Care Recovery Solutions took over management of the facility, the staff has cut the seclusion of patients by 99 percent and the practice of strapping them down by their wrists and ankles by 98 percent. “I didn’t think they’d be able to make the changes they’ve made, but they have the right philosophy and what they’ve done in five months is astounding,” said Christine Griffin, executive director of the Disability Law Center, which has been monitoring conditions at Bridgewater under the settlement of a lawsuit filed on behalf of patients and their families. “It’s all very impressive. I give them credit,” added James Pingeon, an attorney with Prisoners’ Legal Services who has spent decades pushing for more humane treatment at Bridgewater. “The atmosphere is palpably different down there.” Still, many advocates fear that conditions will eventually deteriorate at Bridgewater unless the facility is taken away from the Department of Correction and transferred to the Department of Mental Health. “Bridgewater is still immune from all the laws and regulations that the Department of Mental Health has to abide by,” said Pingeon. “Bridgewater could slide backwards in a hurry.” Governor Baker told the Globe he would be open to discussing transferring the facility to the Department of Mental Health, but would be reluctant to do so if the new model of care is successful. Baker also said he is committed to improving services for mental health patients living outside the criminal justice system. Recent upgrades, he said, include increasing insurance reimbursement rates for mental health care under MassHealth and hiring 50 additional adult case managers at the Department of Mental health to supervise adults with mental illness living in community settings. The failings of the state mental health care system were the subject of a series of Globe Spotlight Team stories last year. -See the full Boston Globe article.
AskHarry.info- Ask an Elder Law Attorney Margolis & Bloom managing partner Harry S. Margolis has created a new website to answer consumer questions about estate planning issues at AskHarry.info.
Division for Children & Youth with Special Health Needs Community Support Line The Division for Children & Youth with Special Health Needs' (DCYSHN) toll free statewide Community Support Line provides information, technical assistance and resources for families with children and youth with special health needs and the providers serving these families. Resource Specialists inform families about all of the public programs they may be eligible for, and about the state and community-based resources that may provide assistance. They answer questions, do a thorough assessment of family needs and eligibility for services and benefits and provide training to families and providers. Resource Specialists provide information and assistance about and eligibility for a broad range of programs including:
Families and providers are welcome to call the Community Support Line for assistance. The Resource Specialists' goal is to help answer specific questions and requests, as well as to ensure that families are informed about all the public programs they may be eligible for, and community resources that might provide additional assistance. Resource Specialists are available for follow-up assistance with families, and often have multiple contacts with a family. For more information about the Community Support Line, contact Sandra Broughton, Director of Community Support at 617-994-9819. Community Support Line 1-800-882-1435-From Community Support Line website, lead from Mass. Network of Information Providers, e-mail, August 3, 2017.
New PAIR Initiative to Support Individuals in Recovery with Personal Grants Mayor Martin J. Walsh and the Mayor's Office of Recovery Services this month announced the launch of the PAIR Initiative (Personal Advancement for Individuals in Recovery), a seed grant program that will consist of grants to individuals in recovery for personal wraparound services needed to maintain and continue recovery. The PAIR Initiative is a partnership between the City of Boston, Warren and Doris Buffett's Letters Foundation, and the Gavin Foundation, and is thought to be the first program of its kind in the United States. The Letters Foundation will be answering requests from individuals in recovery at the Gavin Foundation to support their housing, educational and workforce development goals. The Letters Foundation has committed $100,000 to this pilot, and will give approved funds directly to the vendor or program on behalf of the participant. This initiative is designed for low-income or unstably housed individuals in early recovery, many of whom will be reentering the community from correctional facilities. "It's hard to maintain your recovery if you don't have a roof over your head, a meaningful job, or opportunities for personal advancement," said Mayor Walsh. "The PAIR initiative will allow us to better support people in recovery as they get their feet on the ground. Those in recovery are taking their lives one day at a time -- but we need to ensure they have access to critical services like rent, education and training. Together with our partners, and this new program, we will continue our work to end addiction in our City." While Massachusetts has a robust substance use treatment system, many individuals struggle to maintain their recovery due to economic instability or a lack of meaningful advancement opportunities. The 2016 US Surgeon General's report, Facing Addiction in America, emphasizes the importance of individuals in substance use recovery developing "Recovery Capital" - which includes "housing, education, employment, and social resources" - as a central piece of maintaining their recovery. The PAIR initiative will build this Recovery Capital for those entering the recovery community. Participants will be referred and comprehensively supported by the Gavin Foundation's full continuum of treatment and recovery support services, ranging from acute services (detox) to sober housing, with additional support provided by the Mayor's Office of Recovery Services. Gavin case management staff will refer individuals, who have demonstrated a consistent commitment to their recovery, to the PAIR Initiative after creating an individualized action plan for each participant. Applicants will then write a personalized letter explaining their specific hardship and request seed grant funding for a specific housing, workforce, or education goal that will alleviate their stated hardship. Upon reviewing the materials, Letters will evaluate Gavin's referrals and fund approved requests on the applicant's behalf directly (i.e. assisting an individual with their rent by paying the landlord directly; directly purchasing a textbook for a college or training course). Timelines and grant amounts will vary dependent on the individual's needs and goals. Gavin staff will support the grant recipient throughout this process and help ensure that they are responsibly meeting their individualized action plan. -See the full press release.
Find Out if Your Boston Apartment has a History of Problems, and What To Do if it Does A new city website lets renters or prospective homeowners type in an address and pull up past violations and complaints for that property. The online tool, called RentSmart and available at rentsmart.boston.gov, displays for each property up to five years of information about violations issued by the city, including for housing and building code infractions. It also features data about housing-related complaints as well as sanitation and civic-maintenance-related requests for each address. The tool relies on several databases maintained by city departments. What to do if you spot a problem in your apartment?
-See the full Boston Globe article.
Medicare Open Enrollment Medicare Fall Open Enrollment runs from October 15 through December 7 each year, and it’s a time when you can make changes to your Medicare coverage if you want to. During Fall Open Enrollment, you can
Between October 15 and December 7, 2017, you can make as many changes as you need to your Medicare coverage. The final change that you make will go into effect on January 1, 2018. To prepare for Fall Open Enrollment, you should begin to think about two major things: First, think about your current health and drug coverage. If you have Original Medicare, review the 2018 Medicare & You handbook. This will outline your benefits for the upcoming year. If you aren’t satisfied with Original Medicare, Fall Open Enrollment is a good time to make changes. If you have a Medicare Advantage Plan or a stand-alone Part D drug plan, you should receive an Annual Notice of Change (ANOC) and an Evidence of Coverage (EOC) from your plan. These documents outline which providers, pharmacies, drugs, and services your plan covers, and what costs you will be responsible for. They’ll also tell you what will change in 2018. If you aren’t satisfied (for example, if a drug you need is no longer on your Part D plan’s formulary, or a provider you see is no longer in your Medicare Advantage Plan’s network), you can make changes during Fall Open Enrollment. Even if you are happy with the coverage you get, you should review your current coverage and look at other options in your area to see if there are other plans that cost less and/or better suit your individual needs in the coming year. Next, think about costs. Costs can vary widely between different kinds of Medicare Advantage and Part D plans. Some Medicare Advantage Plans charge an additional premium on top of the Part B Medicare premium. Some Part D plans require people to pay a deductible, while others do not. Another plan in your area could offer you the same or better health and/or drug coverage at a more affordable price or have fewer coverage restrictions. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year. To prepare, create a list of all the health care providers you see, prescription drugs you take, and pharmacies you use. You might receive a lot of mail before and during Fall Open Enrollment, but keep an eye out for any notices from Medicare or your Medicare Advantage or Part D plan. If you decide you want to make changes, you can do so by calling 1-800-MEDICARE. Learn more on Medicare Interactive. -Adapted from What is Fall Open Enrollment, Dear Marci e-mail, Medicare Rights Center, September 04, 2017.
Medicare Rules Waived for Those Impacted by Hurricanes In the wake of Hurricanes Harvey and Irma, older adults and people with disabilities will require additional help to ensure they have access to the Medicare benefits they rely upon. Many may have been forced to leave walkers or other medical equipment behind or lost prescription drugs during an evacuation. They may not be able to use the suppliers or pharmacies that keep their prescription records or are in their plan networks. Some may experience even greater disruptions, such as no longer being able to live in care facilities they called home or losing access to the provider network upon which they depended to live safely in the community. The Centers for Medicare and Medicare Services (CMS) has put into place a number of measures to help address these issues and ensure access to services following hurricanes Harvey and Irma. The measures focus on Medicare rules, since that program is directly administered by CMS. CMS reports that it is also working with state Medicaid agencies to support state-specific emergency measures. Justice in Aging put together a fact sheet for advocates with this information, specifically:
Where to Find More Information Significant additional information is available on the CMS hurricane page, including the disaster declarations for each state, information on relaxation of some HIPPA requirements and modification of reporting requirements for facilities. Seeking Help from CMS Regional Offices If advocates have clients who are having problems accessing Medicare services, Justice in Aging recommend contacting the CMS regional office for Region 6 Office in Dallas for Texas and the CMS regional office for Region 4 Office in Atlanta, which covers Florida. -Adapted from Harvey, Irma and Medicare: Information for Advocates in Texas and Florida, Justice in Aging, September 22, 2017.
CMS Publishes Webpage on Overturn of Medicare Therapy “Improvement Standard” CMS has published a new webpage containing important information about the 2013 Jimmo v. Sebelius Settlement as part of a court-ordered Corrective Action Plan. The webpage provides links to the Jimmo Settlement Agreement, an FAQ and other related public documents clarifying that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, care in inpatient rehabilitation facilities/hospitals. The webpage includes a link to this FAQ page. -Adapted from The Week in Health Care Defense, Justice in Aging, September 01, 2017.
Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications. The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive. Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis. ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them. In contrast, almost every plan covered common opioids and very few required any prior approval. The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found. Many experts who study opioid abuse say they also are concerned about insurers’ limits on addiction treatments. Some state Medicaid programs for the poor, which pay for a large share of addiction treatments, continue to require advance approval before Suboxone can be prescribed or they place time limits on its use, both of which interfere with treatment, said Lindsey Vuolo, associate director of health law and policy at the National Center on Addiction and Substance Abuse. Drugs like Suboxone, or its generic equivalent, are used to wean people off opioids but can also be misused. The analysis by ProPublica and The Times found that restrictions remain prevalent in Medicare plans, as well. Drug plans covering 33.6 million people include Suboxone, but two-thirds require prior authorization. Even when such requirements do not exist, the out-of-pocket costs of the drugs are often unaffordable, a number of pharmacists and doctors said. -See the full New York Times article.
Court Rules Against State’s Effort to End Motels as Shelter A Suffolk Superior Court judge ruled this month that Governor Charlie Baker’s efforts to move homeless families out of motels and into other settings go too far. Under Baker, the state has sharply reduced the number of families housed in motels, which he calls the most disruptive and least effective way to address the “human tragedy” of homelessness. Baker and advocates agree motels are often a poor option for housing homeless families because the move frequently separates them from the support of relatives and friends. When Baker took office at the beginning of 2015, there were 1,500 families in motels at state expense; earlier this month there were 45. Baker has pledged to get the number to zero by the end of his first term. The recent ruling, a preliminary injunction, threatens to stall his efforts. Suffolk Superior Court Judge Douglas H. Wilkins wrote the Department of Housing and Community Development’s “policy of denying motel placements” and putting families in sometimes faraway shelters presents “unique problems for persons with disability who need to visit their treatment providers.” He ordered the state to house families with recognized disabilities in a motel if available shelters couldn’t accommodate their circumstances and the motel could. Ruth Bourquin, the lead lawyer for the plaintiffs in the case, said the court “has recognized that the administration’s unlawful decision not to place families in hotels — even when a hotel will accommodate their needs better than another form of shelter — has made the situation worse for many families.” While the ruling applies broadly, the judge had mandated the Baker administration move several specific families. He said leaving them in accommodations that did not address their disability needs and were too far from their home community would not comply with the state’s right-to-shelter law. That law includes provisions mandating that people’s disabilities are accommodated, that they are housed within 20 miles of their home community as soon as possible, and that the state make “every effort” for children to be able to attend school in the district in which they were enrolled before they became homeless. To reach his goal, Baker’s administration has, with extremely limited exceptions, stopped putting homeless children and their parents in motels. The administration tries to steer homeless children and their parents to relatives or friends. Or, if that doesn’t work, it places them in shelters, even if those rooms are sometimes far away from work and school and can’t accommodate a family member’s documented disabilities. But with limited shelter space in the Boston area, some advocates say motels are the least bad option for certain families to stay close to the services that can get them back on their feet. Massachusetts is unique. It is the country’s only right-to-shelter state. That means when eligible families — those whose incomes are close to or below the federal poverty level — can show they are homeless because of domestic violence, natural disaster, no-fault eviction, or substantial health and safety risks, the state is mandated to provide housing. -See the full Boston Globe article.
Nursing Home Leaders Plead with State for Help
Nursing home administrators and staff are sounding the alarm, telling lawmakers their industry is underfunded and needs help. Three-quarters of the state’s nursing homes have a combined negative margin of 4.4 percent, a statistic that shows a sector “on the brink of collapse,” Salmon said. Chandler said two thirds of the state’s nursing home residents, or around 30,000 people, have their care paid for by MassHealth, which reimburses the facilities at a rate that is based on 2007 figures and clocks in about $37 below the cost of care per day. That gap translates to an average annual loss of $900,000 per facility, or $350 million across all providers. “One of the factors that we have to consider is those more than 400 nursing homes that we currently have, some of them are living from month to month,” Chandler, a Worcester Democrat, told the committee. “They are marginal, and in some of the communities...they can’t afford to lose any nursing homes because the next nearest nursing home may be miles away, miles away in some of these communities, and that is very difficult for a family who has a loved one in a nursing home and wants to be there for that family member.” The push for more state funding for nursing homes comes amid slow-growing tax collections and as lawmakers and Gov. Charlie Baker are looking to rein in escalating MassHealth spending. The state Medicaid program is the largest spending area in the state budget, crowding out other priorities. -See the full Wicked Local article. |