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MGH Community News |
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MGH Community News |
| August 2018 | Volume 22 • Issue 8 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Elena Chace, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
MassHealth ACO and MCO Behavioral Health and Support Services: Community Partners (CP) Program Behavioral Health (BH) and Long-Term Services and Supports (LTSS- programs such as adult day health, adult foster care and the PCA program and durable medical equipment, prosthetics, etc.) Community Partners (CPs) work with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to provide care management and care coordination to certain members identified by MassHealth, ACOs, or MCOs. BH CPs will provide care management and care coordination to certain members with significant behavioral health needs, including Serious Mental Illness (SMI) and addiction. LTSS CPs will provide LTSS care coordination and navigation to certain members with complex LTSS needs, such as children and adults with physical disabilities, developmental disabilities and brain injuries. Members enrolled in an ACO or MCO will be able to participate in the CP program. CPs are not available to members in the PCC Plan or in MassHealth’s fee-for-service program (e.g., members who are dually-eligible for MassHealth and Medicare) unless the member is affiliated with the Department of Mental Health’s Adult Community Clinical Supports program. Where members have other state agency or provider supports, CPs will coordinate with those supports and will supplement but not duplicate the functions provided by them. When the program is fully implemented, MassHealth anticipates that
• BH CPs will support approximately 35,000 MassHealth members, and
*Community First is a policy agenda that seeks to empower and support people with disabilities and elders to live with dignity and independence in the community by expanding, strengthening, and integrating systems of community-based long-term supports that are person-centered, high in quality and provide optimal choice.
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Supports Provided by Community Partners BH CPs perform comprehensive care coordination and care management, including
LTSS CPs are experts in LTSS and perform the LTSS component of care coordination, including
CPs will not be responsible for authorizing services for members. All Person Centered Treatment Plans and LTSS Care Plans must be approved and signed by the member's PCP or PCP Designee. Providers of services that require prior authorization should continue to submit authorization requests to Accountable Care Partnership Plans, MCOs and MassHealth, as applicable. Providers should refer to MassHealth or managed care contracts, regulations, bulletins, and provider manuals, as appropriate, for all applicable requirements for their respective programs and MassHealth services. How Members are Identified for Assignment to a Community Partner
-From https://www.mass.gov/guides/masshealth-community-partners-cp-program
EAEDC Homeless Penalty Ending FY'19 budget language has removed the Emergency Aid to the Elderly, Disabled, and Children program (EAEDC) homelessness penalty. It requires the Department of Transitional Assistance (DTA) to provide full monthly benefits ($303.70/month for a household of one person) to eligible participants who are experiencing homelessness, instead of the reduced grant of only $92.80/month. Under current plans, DTA will begin providing the additional $210.90 in monthly benefits in November to participants under what is known as "Living Arrangement D" *. * From DTA's EAEDC living arrangement definition: (5) Living Arrangement D: an EAEDC individual in one or more of the following circumstances: The Mass Coalition for the Homeless is advocating with DTA for the retroactive removal of the homelessness penalty for July-October as well, so that participants can receive the $843.60 in total additional benefits for those months. -Adapted from email statement from Kelly Turley, Mass Coalition for the Homeless, August 20, 2018.
Drafting Powers of Attorney to Deter Exploitation A power of attorney is an important planning tool. However, a power of attorney can potentially be misused as a tool for exploitation. (Editor’s note: we recommend that staff advise patients and their families to consult an attorney or other competent advisor to ensure this important legal document meets their individual needs.) Older adults should consider including safeguards in power of attorney documents to help deter exploitation. Six safeguards to consider when drafting a financial power of attorney:
Detailed recommendations, some more appropriate for attorneys drafting such documents, are including in Drafting Powers of Attorney to Deter Exploitation, a practice tip from the National Center on Law & Elder Rights. Excerpts Agent selection. The most important step in reducing the risk of exploitation is careful selection of the agent being named. It is essential to name a trustworthy and reliable agent. The agent must be able to help the grantor make and carry out decisions, and commit to making decisions that reflect the values and goals of the grantor. The discussion of who to appoint should go beyond “who do you want to name as your agent?” to include an open discussion of the proposed agent.
Third party accounting. Enlist a trusted third party to do accounting and oversight and ensure transparency. Powers of attorney normally have no monitoring or oversight after the principal loses capacity. Having a second set of eyes on the money provides a minimum amount of transparency. Accountings need not be professional products, but they should at least document the dates, nature, and amount of all financial transactions. The grantor can arrange online access for copies of bank and credit card statements to be sent to the third party. Limit and define gifting power. Gifting money and property using a power of attorney is one of the most common forms of exploitation. The power of attorney should specifically limit and define any gifting authority. While it may be desired to make traditional holiday or special occasion gifts, these can be clearly defined and limited in the document.
Require a second signature on certain transactions. It is bothersome to require two signatures to pay the electric or phone bill. But larger transactions such as the sale of real estate, or cars, can easily be used to exploit. The power of attorney can define transactions, either by type, or by dollar amount that require a second signature. Limit authority. Sometimes exploitation is not discovered until after the grantor is deceased. For example, changing the beneficiary on life insurance, annuity or other contracts, adding rights of survivorship, or beneficiary designations on financial accounts, trusts, or similar instruments, may not be discovered until after the individual dies. It is important to discuss limits to account changes and these limits should be drafted into documents. Power to revoke. The ultimate oversight protection is granting a third party the power to revoke the power of attorney, if the third party believes it is being used to abuse, neglect or exploit the grantor. Often, exploitation begins when the grantor has a limited or no ability to object. Stopping exploitation using a power of attorney can be time consuming if this authority is not created in the document. Additional Resources Drafting Advance Planning Documents to Reduce the Risk of Abuse or Exploitation, National Center on Law & Elder Rights, Issue Brief and webinar recording. Contact – Advocates can contact ConsultNCLER@acl.hhs.gov for free case consultation assistance.
DTA Connect Updates You can help clients apply online and, with proper permission, view case information through DTAConnect.com. For more information about DTA Connect online and the DTA Connect mobile app, visit Masslegalservices.org/DTAConnect. 3 DTA Connect updates:
Reminder, a helping agency should obtain proper client authorization from the client to access DTA Connect (the app or online).
DTA Releases Guidance on Using Housing Rent Computation for SNAP Medical Expenses As reported last month (Public/Subsidized Housing Documentation of Medical Expenses May Now Be Used for SNAP, MGH Community News, July 2018), DTA recently amended its policy to allow SNAP recipients who are elder (60+ years) or disabled (demonstrated by receipt of SSI, SSDI, etc.) to use their public or subsidized housing “rent computation worksheet” as proof of their medical expenses which may then increase their SNAP benefits. For elder/disabled households that have claimed medical expenses to reduce their rent, proof of that amount can be used for SNAP - instead of collecting all the medical receipts.
DTA, with the help of the Mass Law Reform Institute (MLRI), recently drafted a statement to this effect which was sent to community partners. DTA has also issued guidance to the field, Online Guide (see Transmittal Updates 2018 > Transmittal 2018-63). From the community partners letter:
-Adapted from FoodSNAPCoalition listserv post on behalf of Pat Baker, MLRI, August 28, 2018.
DTA Now Offering Video Remote Interpreting for Deaf/Hard of Hearing DTA Clients As part of the Harper litigation settlement, DTA has implemented Video Remote Interpreting (VRI) at 5 DTA offices (Harper was a lawsuit filed by Greater Boston Legal Services to ensure clients with disabilities are properly served by DTA).
For more information about VRI and DTA protocol for assisting clients who are Deaf or hard of hearing, click here to read DTA's VRI guidance.
SSI & SSDI Compassionate Allowances - 5 New Conditions Added On August 20, 2018, the Social Security Administration (SSA) added five conditions to the SSI and SSDI Compassionate Allowances list that fast-tracks disability determination. The new diagnoses are:
Compassionate Allowances fast-track the disability determination process, which is the part of the process most likely to cause a delay. Compassionate allowances do NOT eliminate the SSDI 5 month waiting period. One does NOT need to specifically request a compassionate allowance, in fact there is no separate application process and SSA interviewers cannot request compassionate allowances. Instead the application is reviewed by computer which is programmed to flag the pertinent diagnoses. It is important to specify the pertinent diagnosis, any additional required qualifications as specified on the list (e.g., with distant mets, inoperable, unresectable, etc.), and ensure that the accompanying documentation supports both. See the full Compassionate Allowances list. - See the full SSA Blog post.
Massachusetts Federal Judge Orders Hurricane Maria Evacuees to Leave FEMA Shelters by Sept. 14 A Massachusetts federal judge on Thursday issued an order denying a request for a preliminary injunction to halt the evictions by the Federal Emergency Management Agency of hundreds of Hurricane Maria evacuees still staying in hotels under the Transitional Sheltering Assistance (TSA) program. Worcester U.S. District Court Judge Timothy S. Hillman did extend until the morning of Sept. 14 a temporary restraining order allowing TSA recipients time to transition to alternative housing. "We still have more than 100 families living in hotels," said Rosah Clase, an organizer for the Pioneer Valley Project, which has been working to secure housing for evacuees since they first began arriving in Western Massachusetts following the late September 2017 hurricane. In court documents, Hillman acknowledged that the decision will leave many evacuees with no place to go once the assistance ends. "I agree with the Plaintiffs (hurricane evacuees) that they will suffer disproportionate hardship given that to date, they have not been able to secure alternative housing and therefore, may well be rendered homeless," he wrote. Hillman then called on FEMA to act. "While this is the result that I am compelled to find, it is not necessarily the right result," he wrote. "However, the Court cannot order Defendants (FEMA) to do that which in a humanitarian and caring world should be done -- it can only order the Defendants to do that which the law requires." "While disappointing, today's decision highlights the fact that FEMA has not provided survivors of Hurricane Maria with the housing assistance needed in order to rebuild their lives as evacuees," said Natasha Lycia Ora Bannan, associate counsel at LatinoJustice PRLDEF. "We hope that as the agency mandated to provide such relief to those who have suffered great harm and trauma, they will take the court up on its call to provide a morally correct outcome for TSA recipients." As of Thursday, there are 1,038 families checked in a hotel under FEMA's Transitional Sheltering Assistance program in 27 states and Puerto Rico. -See the full Mass Live article.
New MGH TBI Program A new Traumatic Brain Injury (TBI) program focused on treating neuropsychiatric symptoms after TBI is opening within the Department of Psychiatry starting September 12, 2018. The TBI program aims to:
Free Wage Theft Legal Clinics Wage theft is the denial of wages or benefits that are owed to a worker. The Massachusetts Attorney General’s Office works with community partners to host a monthly wage theft clinic. The goal of the clinic is to help workers get the wages and benefits they earned. If you are owed wages by your employer, you can come to the clinic to speak with a private lawyer for free. You can discuss your case and may get help writing a letter, filing a complaint in court, or taking some other action. If you have these papers, please bring them: pay stubs, time sheets, letters/emails from your employer. You can attend the clinic whether or not you have already filed a complaint with the Attorney General's Office. If you have already filed a complaint with the Attorney General's Fair Labor Division, please bring:
If you need an interpreter, please call (617) 963-2327 at least 1 week before the clinic.
All workers are invited, regardless of immigration status.
Payday Loan Alternatives Even in a strong economy, many Americans live paycheck to paycheck. Forty percent don't have $400 to cover an emergency expense, such as a car repair. And many working-class people turn to payday loans or other costly ways to borrow money. But more companies are stepping in to help their workers with a much cheaper way to get some emergency cash. Startup companies that offer better options for workers are partnering with all kinds of businesses — from giants like Walmart to small mom and pop businesses. PayActiv is one such tech startup that helps companies get their workers emergency cash for very small fees. Safwan Shah, the founder and CEO of PayActiv, says the need out there is huge because so many Americans are paying very high fees and interest when they're short on cash. "Our data analysis showed that it was close to $150 a month being paid by the working poor — per employee or per hourly worker in this country," says Shah. "That's a substantial sum of money because it's about $1,800 or $2,000 a year." Think about that for a minute. According to the Federal Reserve, 40 percent of Americans don't have $400 in savings to fix their water heater or some other emergency. But Shah says they're spending around $2,000 a year on fees and interest to get emergency short-term cash. He thought this was a problem that needed fixing. Shah also realized that often people don't need to borrow very much money. And he says that actually workers have usually already earned the cash they need because they have worked far enough into the pay period. They just haven't been paid yet. "And so we said the problem is really a between-paychecks problem," says Shah. His PayActiv company lets workers get access to that money they have already earned. So at many companies now workers download an app to their phone. It's linked to PayActiv and to the payroll system of the employer. "So let's say they've already earned $900" by earning $100 a day for nine days, says Shah. But payroll is still five days away and they need the money right away. Shaw says they open the app and "they will see a number which is half of the amount they have earned that is accessible to them." So if they need $400 for a car repair or a trip to visit a sick brother, they tap a few buttons and the money gets zapped to their checking account or a prepaid card. And the fee is $5. (Some employers pay the fee or a portion of it.) And a lot of workers are deciding that's a much better option than getting stuck in a cycle of debt with costly payday loans. The app also has some creative ways to nudge employees to build up savings accounts so they're not chronically strapped for cash. The system uses some techniques rooted in behavioral economics. Shah says it asks workers to put, say, two hours of pay a week into savings, because workers respond better to that than to a dollar amount. Laura Scherler, the director of financial stability and success at the United Way says some other companies work with employers to offer workers actual loans — more than just an advance on hours they've already worked. Those get paid back over longer periods of time with interest. Consumer advocates say employers should be careful to make sure that their workers are getting a good deal. But Scherler says there are good lower-cost loan options. "There seems to be a couple of things coming together right now that makes this really exciting. I think employers are increasingly aware that financial stress impacts their workers." And workers seem very aware of that too. More than 100 companies have now signed up with PayActiv. A Walmart executive says there has been an "extraordinary" response from employees. More than 200,000 Walmart workers are now using the system. -See the full NPR story.
Samaritans’ Support Services Families of Suicide Attempt Survivors In collaboration with Riverside Trauma Center, Samaritans is hosting a support group series for family members living with a loved one who has attempted suicide or has had long-term suicidal ideation. This group provides a space for individuals to talk openly with others who are dealing with the complicated emotions of this experience. During the support group, participants will gain information on how to support their loved ones, as well as learn healthy coping skills for themselves. Meetings are held weekly in Needham for six weeks, and there is no fee for participation. Grief Support Services for Those Who Have Lost Someone to Suicide The Samaritans’ Grief Support program offers services to those who have lost someone to suicide.
These services are available to any individual who has lost a loved one to suicide and they are entirely free of charge. -Outreach materials and additional information available from Allison Perri Newman
Pregnancy and Infant Loss Group in Acton Emerson Hospital and First Connections are offering a free Pregnancy and Infant Loss group in Acton, MA that is open to anyone in the community, regardless of where they receive care. This group is most appropriate for those with second and third trimester losses or losses shortly after birth. Families currently in the group don’t have NICU experiences. The group is facilitated by an advanced practice nurse with experience supporting families whose pregnancies have ended unexpectedly or whose infants have died. The group meets on the second Monday of each month from 6:30pm –8:00pm at First Connections- 179 Great Road, Suite 104A, Acton, MA. The remaining 2018 dates: 9/10, 10/8, 11/12, and 12/10. Interested individuals are encouraged to contact the facilitator, Katie Stockman, NP, at kstockman@emersonhosp.org or (978) 287-3422 before attending, though this is not required. In the event of severe weather please contact Katie for confirmation the group is running.
New MAGI Tax Filing Threshold May Affect Medicaid & ACA Cost-Sharing Reduction Eligibility Under Modified Adjusted Gross Income (MAGI) rules, which determine eligibility for Medicaid expansion and certain other Medicaid categories, as well as ACA premium tax credits and cost-sharing reductions, the income of dependents with earned-income over the tax filing threshold is included in total household income. The Tax Cuts & Jobs Act enacted last December established a new, higher filing threshold of $12,000 for individuals under age 65, which applies to the 2018 tax year. This means that more individuals and families will be Medicaid eligible because their dependent’s income above the previous $6,350 threshold that would have been included under the old rules is now excluded. For more information, see the National Health Law Program’s updated MAGI Guide. Healthcare.gov (the federal exchange) has already adopted the new tax filing thresholds for 2018 MAGI-based eligibility determinations, and state Medicaid programs should be using the new filing threshold as well. If not, your state may be wrongfully denying Medicaid eligibility to individuals who have dependents who have income. - From Justice in Aging, August 24, 2018.
Medicare Reminder: Home Health Benefits
Medicare’s home health benefit covers some home health services for people who meet eligibility requirements, including needing skilled care and being homebound.
Medicare’s home health benefit does not cover all home care services. Services excluded from Medicare coverage include:
For people who are terminally ill, Medicare covers some of the above services if the person elects the hospice benefit.
Medicare Reminder: Medicare Part D Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.
Part D plans must also cover most vaccines, except for vaccines covered by Part B. -From Medicare Watch, Medicare Rights Center, August 02, 2018.
Medicare Reminder: Part D and Retiree Insurance Plans Some retiree insurance plans offer prescription drug coverage. If your retiree insurance offers creditable drug coverage and you prefer it to Part D, you can delay Part D enrollment without penalty. Finally, some companies offer their own Part D plan as their retirement drug coverage; if this is the case you cannot have that coverage and another Part D plan. Contact your benefits administrator or your employer’s human resources department before making Part D enrollment decisions. -From Medicare Watch, Medicare Rights Center, August 23, 2018.
New Fact Sheet: Enrolling in Qualified Medicare Beneficiary (QMB) Program for People Otherwise Subject to Medicare A Premiums Many people do not have enough work history to qualify for premium-free Medicare Part A benefits, however there is still an option for low-income individuals to get their Medicare Part A premiums paid. A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Under the QMB benefit, state Medicaid programs pay the over $400/month Part A premium in addition to the Part B premium. QMBs also enjoy protection from improper billing of Medicare deductibles and co-insurance. The QMB program is generally available to people with incomes at or below 100% of the Federal Poverty Level with limited assets. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the state’s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants. To address these problems, the Social Security Administration recently issued revised directions to its staff on how to handle conditional Medicare Part A applications from individuals planning to apply for Qualified Medicare Beneficiary program benefits with their state Medicaid agency. The revisions to the Program Operations Manual System (POMS) do not include substantive changes, but provide more detail on how SSA offices should handle conditional Part A applications and discuss how local Security Offices should handle state variations. The revisions should go a long way to address inconsistencies that advocates have reported in SSA office procedures. Advocates can use the revised POMS to explain to their clients exactly what they should do to apply. Bringing copies of the POMS provisions with them to the SSA office will also ensure that SSA personnel use appropriate procedures. What Applicants Should Know (adapted from the new Justice in Aging fact sheet) In Massachusetts and all of the New England states
Residents of 14 states (Alabama, Arizona, California, Colorado, Illinois, Kansas, Kentucky, Missouri, Nebraska, New Jersey, New Mexico, South Carolina, Utah and Virginia) may only apply at SSA for conditional Part A enrollment between January 1 and March 31. (For more information- see the fact sheet.) In all states:
For more information see the Justice In Aging fact sheet. -Adapted from Helping your low-income clients get coverage for Medicare Part A, Justice in Aging, August 06, 2018.
New Medicare Cards Being Sent to Beneficiaries in Wave 4 States – Including MA The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires the Centers for Medicare & Medicaid Services (CMS) to remove beneficiaries’ Social Security Numbers (SSNs) from Medicare cards by April 2019 to mitigate risk of medical identity theft. To do this, CMS is replacing beneficiaries’ SSN-based Health Insurance Claim Numbers (HICN), which are currently used to process claims and determine eligibility, with non-SSN based Medicare Beneficiary Identifiers (MBI). CMS will generate MBIs for all existing (current, deceased, and archived) and new beneficiaries. In April 2018, CMS started sending new Medicare cards with a new MBI to beneficiaries on a rolling basis, to conclude in April 2019. Starting in July, beneficiaries in the Wave 4 states of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont started receiving new cards. Current beneficiaries are mailed a replacement Medicare card and instructions. CMS has created a webpage with information and resources for a variety of audiences, including beneficiaries, partners and providers. The resources include 10 Things to Know about Your New Medicare Card and other consumer-facing materials in English, Spanish, Korean, Chinese, Japanese, Vietnamese, and Arabic. SSA is encouraging beneficiaries to destroy their old cards once they receive their new ones, to help avoid identity theft. They also want beneficiaries to beware of anyone who contacts you about your new Medicare card. We’ll never ask you to give us personal or private information to get your new Medicare Number and card. Sample new card:
-For more information, see the resource sheet from the National Center on Law and Elder Rights (NCLER).
CMS Announces New Rules That Will Complicate Part D Drug Formularies This week, the Centers for Medicare and Medicaid Services (CMS) announced that, starting in 2020, Part D Plans and Medicare Advantage Plans with Part D will be able to include medications on their formulary for some FDA-approved uses, but not others. Currently, a plan can favor one drug over another by including a medication on its formulary or not; placing it on a lower cost sharing tier; or putting coverage restrictions, like prior authorization, quantity limits, or step therapy on the less preferred medication. These rules apply uniformly to each drug, for all FDA- and compendia-approved purposes—the new rules do not. For example if drug A is FDA approved for two uses—one to treat condition X and one to treat condition Y—plans must include drug A on the formulary for X and Y or exclude it for both X and Y. Under the new rules, however, plans will be able to treat a prescription for a drug to treat X differently from the same prescription to treat Y. CMS indicates that their intent is to increase a plan’s ability to negotiate indication-specific drug prices, but there are few details about how these differences will be communicated to beneficiaries. The memo from CMS states that if plans wish to use this type of formulary design they must “disclose that some drugs may be subject to those requirements in the plan’s Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents.” We believe this is inadequate – CMS should require integration of this information, including asking about the conditions for which drugs are prescribed, in the Medicare Plan Finder tool. Plans should also be required to designate any drugs that have indication-based restrictions in their online and print formularies. Medicare Rights is concerned that people with Medicare will face ever-growing difficulties in choosing what coverage is right for them. Already, many people struggle with their coverage decisions, and new complex plan offerings are likely to increase these problems. -From Medicare Rights Center, blog post, August 30, 2018.
Public Charge- Clarification and New Advocate Reference Protecting Immigrant Families (PIF) has issued the following Public Charge clarification and a new resource for advocates to aid discussions with anxious immigrants. Several news articles claim that public charge rule changes will impact people applying for US Citizenship and/or people seeking green card renewal. Is that correct?
Earlier this month PIF released a new resource: How to Talk with Immigrant Families About Public Charge. This document explains that the public charge determination includes a balancing of negative and positive factors and is a forward-looking test. They do not recommend saying that nothing has changed. While the public charge proposed rule has not yet been published or finalized, they have started to see an uptick in consular denials due to public charge changes in the Foreign Affairs Manual. Therefore, they recommend saying “the rules governing public charge determinations in the U.S. have not yet changed.” Excerpts from How to Talk with Immigrant Families About Public Charge Topline Messages
Detailed Talking points The rules on public charge decisions made within the U.S. have not yet changed. While U.S. consulates abroad have started applying public charge tests more broadly, these changes apply only to individuals who are seeking to enter the U.S. from abroad or who must go abroad to process their applications. For green card applications processed by U.S. Citizenship and Immigration Services (USCIS) in the U.S., public charge rules have not changed. The rule is still in draft form. It cannot be implemented until it becomes final, which will take additional time. The Trump administration has not actually proposed the rule yet. We have seen only incomplete drafts. If the administration publishes the rule, the law gives all of us a chance to speak out in opposition before the government finalizes the rule. Once comments about the rule are submitted, the review process can take months. If the rule is finalized, it may not take effect until several weeks or months after the final version is published. Some immigrants are exempted by law from the public charge test. Exempt immigrants include: refugees; asylees; survivors of trafficking, domestic violence, or other serious crimes (T or U visa applicants/holders); VAWA self-petitioners; special immigrant juveniles; certain people paroled into the U.S.; and green card–holders applying for U.S. citizenship. Even if the draft regulation is finalized, these groups will not be subject to the public charge test. If the rule is finalized, you will have time to act before the rule goes into effect. Based on leaked draft proposals, benefits previously excluded from the public charge determination (such as Medicaid and SNAP, the Supplemental Nutrition Assistance Program) will be considered only if those benefits are received 60 days after the final rule is published. Using benefits now can help you or your family members become healthier, stronger, and more employable in the future. Families need to make individual determinations based on their unique circumstances. Get help deciding what’s best for your family and, if you can, consult with an immigration attorney or BIA-accredited representative about your own situation. You can use this online directory to search for local nonprofit organizations that provide legal help and advice: https://www.immigrationlawhelp.org/. See the full advocacy resource: How to Talk with Immigrant Families About Public Charge -Adapted from PIF Campaign: Frequently Asked Questions, Webinars, and Resources, Protecting Immigrant Families, August 27, 2018.
Boston Reduces Chronic Homelessness as It Rises Nationally Boston has reduced chronic homelessness 20 percent since 2016, according to new city data to be released.This decrease has happened at the same time the problem is growing nationally, city officials say. A U.S. Department of Housing and Urban Development report found chronic homelessness increased 12 percent between 2016 and 2017. The government defines a chronically homeless person as someone with a disabling condition who's been homeless for at least 12 consecutive months or has had at least four periods of homelessness totaling at least 12 months in the previous three years. At the beginning of 2016, there were 612 people known to be chronically homeless living in emergency shelters and on the streets in Boston. Since that time, the city and its homeless service providers have placed 580 chronically homeless individuals in permanent supportive housing. More than 800 additional people have become chronically homeless since January 2016. When the city last compiled its official list of people who are chronically homeless, over the winter, there were 493 on it. The list is updated and released a couple of times a year. As part of the action plan, the city implemented a software program that matches people on the chronically homeless list with available housing units — including subsidized housing run by Boston Housing Authority and private units with rental assistance vouchers tied to them or that accept vouchers from tenants. All of the homeless shelters and homeless service providers are tied into another computer system that allows them to see where a homeless person has been staying night to night. Another program offers so-called "front-door triage" services to people when they first enter the public or private shelter system. The goal of that program is to move people out of homelessness very quickly or to find a way for a person to not have to stay at the shelter at all — thereby averting chronic homelessness. Laila Bernstein, who is heading up the city's effort to end chronic homelessness, says a shortage of affordable and subsidized housing in the city is a huge barrier. "It's hard to make a ton of progress without more federal investment. And part of why we saw so much success on the veterans initiative... is because there's a huge federal investment in housing for homeless veterans. And there was all this political will," she says. The opioid epidemic has also contributed to homelessness over the last few years. But, Bernstein says, one of the biggest factors affecting the city's ability to end chronic homelessness is that before the initiative started, city officials really didn't know how severe the flow of people into the emergency shelter system was. The different shelters and service providers just weren't communicating, coordinating and tracking numbers like they are now. -See the full WBUR story.
Alzheimer's Law Signed by Governor Baker This month Governor Baker signed An Act relative to Alzheimer's and related dementias in the Commonwealth into law. The legislation helps patients and their families receive better, more comprehensive care. Caregiving for people with Alzheimer’s is an energy- and time-intensive endeavor and when medical emergencies occur for unrelated conditions, people with Alzheimer’s and related dementias often fare poorly in the acute care setting. This bill helps ensure that caseworkers, medical providers and hospital administrators and staff better understand Alzheimer’s disease so that they can provide the best treatment possible for patients and clients who are brought to them. An Act relative to Alzheimer’s and related dementias in the Commonwealth supports individuals with Alzheimer’s and dementia and their families by:
-See the press release from Senator Jason Lewis.
Baker Signs Bill to Combat Opioid Epidemic The Massachusetts legislature recently passed An Act for Prevention and Access to Appropriate Care and Treatment of Addiction and Governor Baker has signed the bill into law. To continue to reduce the number of overdose deaths and reduce opioid addiction rates, the legislation increases access to medication-assisted treatment (MAT), expands prevention efforts, and addresses the high rates of co-occurring conditions of substance use disorder (SUD) and mental illness. Under this bill, someone who receives treatment in an emergency room for an opioid overdose will now have the opportunity to begin treatment for their substance use disorder before they leave the care of the emergency department. The bill requires that all emergency facilities have the capacity to initiate voluntary SUD treatment, including opioid agonist treatment, after treatment for overdose. Opioid agonist treatment commonly includes the use of Buprenorphine, also known as Suboxone, which is an evidence-based treatment that eases the symptoms of withdrawal and relieves opioid cravings. It can be administered as early as 8 to 24 hours after a patient's last exposure to an opioid. This timetable allows treatment to begin in the emergency department soon after an overdose, when someone with a SUD may be most willing to consider treatment. They will also receive a direct referral to a provider in the community who can continue their treatment regimen after they return home. The legislation also directs the Department of Public Health to issue a statewide standing order authorizing every pharmacy in the state to dispense naloxone (narcan), eliminating the current requirement that each pharmacy obtain an individual authorization, and making this life-saving medication even more widely available.
In addition, this legislation recognizes the important role that recovery coaches play in successful long-term addiction and mental illness treatment by creating a commission to recommend standards for establishing a professional credential for recovery coaches as an important step toward formalizing the role that they play in the pathway to treatment and recovery. -See the full Patch article.
Trump Administration Expands “Short-Term” Health Plans, Jeopardizing Coverage for Millions This month, the Trump Administration issued a final rule expanding the availability of “short-term” health plans that do not have to comply with the Affordable Care Act’s (ACA) consumer protections and coverage requirements. In particular, short-term plans are free from the ACA’s insurance regulations–including the mandate to cover essential health benefits like maternity care, prescription drugs, and mental health treatment—as well as from the health law’s consumer protections that prevent insurers from charging sick people more than healthy people, excluding coverage of pre-existing conditions, and denying coverage based on medical history. Under the final rule, these policies will now last up to 12 months, and consumers will be able to renew them for a maximum of 36 months. Previously, the plans were limited to three months and were not renewable. Since they can cover fewer services and deny coverage for serious medical needs, these bare-bones plans are typically cheaper than traditional insurance. As a result, they are likely to attract younger, healthier consumers who do not think they need the ACA’s more robust coverage. As these consumers exit the individual market, they will leave behind an older, sicker risk pool. Insurers will likely raise premiums and decrease plan choices in response—endangering the health and economic security of millions of Americans, including those nearing Medicare eligibility. According to recent estimates, broadening access to short-term plans could increase individual market premiums by 18.3% in 2019. For a 60-year-old buying mid-level coverage, this could mean a $4,000 monthly premium hike. Throughout the rulemaking process, the Administration has contended that expanding access to short-term insurance that bypasses key ACA requirements will “increase insurance options for individuals unable or unwilling to purchase [ACA]-compliant plans.” The Medicare Rights center said in a statement that “these plans circumvent many ACA protections and are therefore not a realistic option for people with pre-existing conditions, who would likely either have services for those conditions excluded from coverage or be denied coverage altogether. Consumers who could qualify for and afford short-term coverage would also be at risk, as these plans are unlikely to protect those who buy them.” The statement says that an estimated 4 million people have lost coverage since 2016. This rule will add to those losses, especially in conjunction with the recent expansion of non-ACA compliant coverage for small businesses and associations. The Administration also drastically cut funding for the federal program that helps people enroll in ACA plans and other health coverage. To top it off, the Justice Department is legally challenging—and seeking to eliminate—the ACA’s coverage protections for people with pre-existing conditions. All of these changes are likely to lead to more erosion of recent coverage gains for millions of people. Read their comments on short-term plans. Read more about short-term plans. -See the full Medicare Rights Center Blog post
A New Role for Paramedics: Treating Patients at Home A small number of paramedics in Massachusetts are now working in pilot programs that allow them to treat patients with urgent medical needs at home, a practice that soon will be more common through money included in the recently approved state budget. Under the supervision of physicians, and with special training, these paramedics — part of an emerging field known as community paramedicine or mobile integrated health — can examine patients, administer medications, and provide care instructions. The goal is to avoid unnecessary and costly hospital visits while treating patients where they are most comfortable. These programs, proponents say, can be particularly helpful for patients who are frail, elderly, have chronic conditions, live in remote areas, or need care at night when doctor’s offices are closed. The concept has critics who worry whether paramedics have the right training to treat patients at home. But many in Massachusetts have high hopes and argue that expanding the role of paramedics is an important strategy for slashing health care costs and improving patient care. With an additional $500,000 included in this year’s state budget, the Department of Public Health is hiring five people to run the state’s mobile integrated health program and expects to begin accepting applications this fall. In August, health officials adopted new state regulations that govern these programs. Paramedics responding to emergencies are generally required to take sick patients to a hospital, unless the patient refuses to go. But the new state rules waive this requirement for medics who are part of mobile integrated health programs. Such efforts are underway in many other states, though Massachusetts officials say their initiative will be the most comprehensive in the nation. As it is implemented, they are likely to draw on the experience of two local ambulance companies, EasCare and Cataldo, which have been experimenting with programs over the past four years. The expanded role for paramedics is in some ways similar to what visiting nurses have been doing for many years. But nurses typically visit patients on regular schedules — not for emergencies. And while nurses have higher levels of training, they don’t carry the stock of medicines that paramedics have in their ambulances.
Ambulance companies stand to benefit from the new state rules that allow them to grow their business with these new programs. The programs also might appeal to health care providers and insurers who have a financial stake in managing the health of their patients and are trying to reduce costs. More than 40 percent of emergency room visits are thought to be avoidable; they involve patients with problems that safely could be treated in less costly settings, according to state estimates.
“Paramedics aren’t trained in chronic care management,” she said. “A paramedic is just jumping in, putting a Band-Aid on something, and leaving.” -See the full Boston Globe article.
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