Highlights

• Government Shutdown and SNAP
• New Assisted Living Disclosures Required
• South Shore Mental Health Name Change
• HelpSteps Resource Finder
• Logan Medical Patient Assistance
• Weekly Clubs at CRP Patient Memberships
• YMCA Corner Stone Program for CA Patients
• 911 via Text
• SNF Advocacy Guide
• Debt Collection Rights
• Health Story Collaborative
• All Should Have New Medicare Cards
• CRC Alum in Spotlight
• BHP Now Covers rTMS

Sections

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

Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807.

MassHealth PT-1 Enforcing 3-Day Notice Requirement and Address Change Policy

As of February 1, 2019, MassHealth members with PT-1 transportation will be required to contact their RTAs to schedule transportation at least three business days in advance of the day on which the transportation will occur.

The MassHealth patient notice gives the following guidance:

• Contact your RTA by Monday to schedule transportation for the following Thursday.
• Contact your RTA by Tuesday to schedule transportation for the following Friday.
• Contact your RTA by Wednesday to schedule transportation for the following Saturday, Sunday or Monday.
• Contact your RTA by Thursday to schedule transportation for the following Tuesday.
• Contact your RTA by Friday to schedule transportation for the following Wednesday.

RTAs will schedule transportation with less than three business days’ notice if the member has an immediate need for treatment, the member will be receiving urgent care, or rescheduling the visit will negatively affect the member’s condition. If a member notifies his or her RTA that such circumstances apply, the RTA will contact the member’s provider to confirm.

We’ve been assured that RTAs are expected to provide all requested trips, that any delay or difficulty in obtaining confirmation should not pose a barrier to care.

Rolando Mercado, iCMP Senior CRS, shared the following from a MassHealth contact:
People who are medically complex and have frequently changing health needs or people who need urgent next day appointments will continue being able to book them. We have stressed to our transportation providers that they still have to fulfill every trip request and cannot deny service based on the timeframe. In the event that a transportation broker says they cannot book a trip because of the three day rule, the member or person booking the trip should say the trip is urgent.

The Community Resource Center would welcome any feedback about how this is working - please contact Ellen Forman.

Address Changes

Additionally, when a MassHealth member reports a new residential address, providers will need to submit a new PT-1 within 30 days (or sooner if the PT-1 expires within that time). Or put another way, PT-1 forms will remain valid until the sooner of the PT-1 form’s end date and 30 days after the date of the address change. Providers will need to submit new PT-1 forms to authorize future transportation.

See the MassHealth All Provider Bulletin 280, January 2019.

-Thanks to Rolando Mercado and to Brooke Alexander their assistance with this article.

During the partial government shutdown, the USDA utilized a provision in the just-expired Continuing Resolution (CR) budget appropriation to fund February SNAP benefits. The provision provides payment for program operations within 30 days of the CR’s expiration. Payments had to be made early to fall within that 30 day window, so February SNAP benefits were paid by January 20th.  SNAP households will not get another SNAP payment until March (assuming the government remains open).

DTA placed robocalls in late January to about 93% of the caseload issued early SNAP benefits (or 420,000 households). MLRI reports that the robocall said: 

This is the Department of Transitional Assistance. You will receive your February SNAP benefit early, within the next few days. You will not get another SNAP benefit issuance in February. Please spend carefully to ensure that your benefits last throughout February. For updates, please visit www.mass.gov/dta. 

MLRI has expressed concern that households may be confused because they had already gotten the early issuance when they got this message - they will NOT be getting another issuance in the "next few days." Limited English Proficient clients may also not have been adequately informed because the robocalls were only in English and Spanish. 

If the shutdown resumes after February 15th, SNAP will still be funded for March benefits. If the shutdown resumes and continues into March, April benefits may need to be issued early (similar to the procedures used for February’s SNAP). However, there is much unknown about how USDA and states will handle issuance after March should the shutdown proceed.

Long Interval Between Payments Causes Hardship

Advocates are also raising alarms about the hardship posed by a long interval between the January 20 and March issuance of benefits. “This is an extraordinarily long time for families to wait, especially given February’s week of school vacation where kids will be missing out on free breakfast and lunches.” Said MLRI in a statement “SNAP is often not enough to meet a family's food needs in the first place.” The Center on Budget and Policy Priorities issued a report that says in part:

It’s well documented that SNAP benefits normally run out for most households before the end of the month. Within a week of receiving SNAP, households redeem over half of their SNAP allotments. By the end of the second week, SNAP households have redeemed over three-quarters of their benefits, and by the end of the third week they have redeemed 90 percent.

Because SNAP benefits often fall short of meeting basic monthly food needs, and because struggling households have to use available cash to meet non-food expenses, families can find themselves at the end of their 30-day SNAP benefit payment cycle without enough food or the resources available to buy more food. Research has found that food spending, food consumption, and diet quality fall and that food insecurity, hospital admissions, and school disciplinary problems rise after households have exhausted their monthly SNAP benefits. SNAP families often have to turn to social networks, food pantries, and others to get through the month.

Given the experience of the strain on low-income households’ budgets and community resources under normal SNAP issuance patterns — when the gap between SNAP issuances is no more than 31 days — stretching that gap to 40 to 50 days or longer could create substantial hardship and hunger and sharply increase demand for local emergency food providers and other community social services providers.

For more information and updates see MLRI’s Information Regarding the 2019 Federal Government Shutdown & Impact on Benefits Programs page.

- Adapted from MLRI government shutdown memo, Wed 1/23 SNAP & Shutdown UPDATE - DTA robocalls + shutdown storybank!, FoodSNAPCoalition listserv on behalf of Victoria Negus, MLRI, January 23, 2019 and the CBPP report.

Since April 2016, more than 20,000 Able-Bodied Adults Without Dependents (ABAWDs) have lost SNAP in Massachusetts. In addition to the hundreds who are terminated every month, nearly 1,000 more are at risk of losing SNAP come April 2019. 

Since 2016 when the ABAWD work rules went back into effect in Massachusetts, certain areas of the state with elevated unemployment have been "waived" from the work requirement- meaning ABAWDs who live in those areas don't need to meet the punitive work rules. Each year - because of rising employment and an improved economy - the parts of the state waived from the ABAWD work rules has shrunk. 

As of January 1, fewer cities and towns are exempt from the ABAWD work rules. The state has posted lists of the towns currently exempt, and the towns that have lost the exemption (also listed belowl). DTA automatically updates this in the eligibility system and the nearly 1,000 ABAWDs who are no longer exempt were sent a notice. 

Advocacy Tips

There are thought to be thousands of ABAWDs who have already been cut off who may actually be eligible for SNAP. 

• If someone was told they need to meet the ABAWD work rules, first check to see if they are exempt! Many ABAWDs are actually "unfit for work," are caring for someone with a disability, or meet another exemption. 
• If someone lost SNAP because they didn't meet the work rules, advise them to re-apply! Many ABAWDs are eligible for at least 3 more months of SNAP (because the 36 month "clock" re-started in January 2018), and likely are eligible for more. 

For fliers and materials, including more information on how to screen ABAWDs for exemptions and a map of the areas that are currently waived, go to: MassLegalServices.org/ABAWD

Vicky Negus from MLRI wants to hear advocate’s ABAWD stories. Contact her at 857-241-1715 or vnegus@mlri.org!
The areas listed below were waived from January 1 through December 31, 2018, but will no longer be waived as of January 1, 2019.

ABAWDs living in these MA Communities are now subject to the ABAWD Work Requirement:

- From FoodSNAPCoalition listserv on behalf of Victoria Negus, MLRI, January 3, 2019.

Effective January 1, 2019, the Executive Office of Elder Affairs (EOEA) now requires all Massachusetts assisted living providers to provide a standard consumer disclosure statement with each new residency contract.  According to a Memorandum from EOEA, the mandated disclosure is intended to explain issues that are often overlooked or misunderstood when people choose to move into assisted living, particularly issues of fees and services that are included (or not included) in the agreement.  Among other things, the disclosure states that assisted living residences are not the same as nursing homes, cannot provide skilled care and are not required to have nurses on-site. 

Excerpts from the standard consumer disclosure statement:

• A signed residency agreement is a contract between you and the ALR; read it carefully before signing. Note: If additional services are subsequently required, your monthly costs may increase.
• Eviction from an ALR must comply with the provisions of landlord/tenant law, M.G.L. c. 186 or c. 239, and include all notices required by law.
• The ALR cannot prevent you from returning to the ALR after a hospital or rehab stay; however, if your care needs exceed the ALR’s capacity for services you may be required to hire private care staff to meet your care needs.
• You should assess your finances to determine how long you can afford to stay at the ALR before making a commitment.
• If you deplete your assets (run out of money) and are unable to afford the cost of the ALR in the future, the ALR may require you to move.
• The ALR can change your monthly fees with ___ days’ notice.
• Your service plan can change based on the ALR’s reassessment of your needs. Changes to your service plan may change your monthly costs.
• Residents may file a complaint at any time with the Assisted Living Residence Ombudsman or the Assisted Living Residence Certification Unit at Executive Office of Elder Affairs by calling (617) 727-7750 or 1-800-AGE-INFO (1-800- 243-4636).

-See the full Margolis & Bloom blog post.

Human service activists and lawmakers rallied outside the State House earlier this month, calling for the state to help offset a cut in federal funding by allocating $30 million to help low-income families afford winter home heating bills.

Most of the 48,000 households in Massachusetts that heat with oil have used up their benefits, according to the Massachusetts Association for Community Action, which said 160,000 households in Massachusetts are served under the Low Income Home Energy Assistance Program.

With heating oil costing nearly $3 per gallon, the current federal funding will cover the cost of 1.75 tanks of oil for one household, said advocates. However, it usually takes three to four tanks of oil to heat a household through winter in Massachusetts.

Applications for this year's program show an increase of over 20 percent from last year.

Funding for the federal program was reduced by $11 million this year, and has over several years been cut from $200 million a year to $136 million per year, MASSCAP said.

The state has approved supplemental funding for the program more than a dozen times over the past three decades, according to MASSCAP.

During winter months these people can be forced to choose between heating their homes and other necessities. Activists said they have not been able to meet with the governor to discuss the proposal, but many senators and representatives attended the press conference to show their support.

- See the full State House News article on the WBSM website.

The 2019 Federal Poverty Levels have been released by HHS but publication in the federal register has apparently been delayed by the shut down. For comparison, 100% FPL for one person will go from $12,140 to $12,490 when the new income levels take effect.

MassHealth will implement the 2019 poverty levels March 1 & MLRI will update our Table of MassHealth Upper Income Limits at that time too.

Remember the Health Connector will continue using the 2018 poverty levels to determine eligibility for coverage throughout calendar year 2019. It will not begin to use the 2019 FPLs until open enrollment for 2020. 

Meanwhile you can see the 2019 poverty levels here
https://aspe.hhs.gov/poverty-guidelines

- From 2019 FPL & more shut down info, Health-announce listserv on behalf of Vicky Pulos, MLRI, January 17, 2019.

As of January 7, 2019, South Shore Mental Health has changed their name to Aspire Health Alliance. There will be no change in services or providers.

Their phone numbers remain the same, including their Main number (617-847-1950), Intake Department (617-847-1914) and Crisis Team (617-774-6036, 800-528-4890). Their new website is www.aspirehealthalliance.org.

-Thanks to Marie Elena Gioiella for sharing this update.

The recent case of Stephanie Crosman is highlighting lax oversight of home health care workers in the state. Crosman allegedly used the credit card of one client - a woman with dementia - to pay a $1,500 veterinarian bill for her cat, part of a freewheeling $16,000 spree. Another client, a woman in her 80s, accused Crosman of writing forged checks on her bank account. And Crosman’s own cousin reported Crosman to police, saying she stole expensive jewelry from her house.

Yet, despite these charges and at least one other client who accuses her of theft, Stephanie Crosman was still making money as a home aide late last year.  She even has a state license as a licensed practical nurse, and she was on the state list of certified nurse’s assistants until her certification expired last month. Her family believes she’s in Rhode Island or Connecticut and worries she may still be victimizing people.

A Globe investigation last year found dozens of Massachusetts aides hired to care for elderly, sick, and disabled people at home have faced allegations that they abused or neglected their clients.

But Crosman is emblematic of the serious lack of oversight of the home care industry. Chief among them is that no single agency in Massachusetts keeps track of the home aide workforce or ensures that crimes by aides are reliably reported to appropriate state agencies. Relatively few alleged abusers are prosecuted; when they are, they seldom get substantial jail time.

The Board of Registration in Nursing, which oversees licensed practical nurses — some of whom do home care work — does not automatically check criminal records of applicants. The agency finally began investigating Crosman’s license in December based on a complaint, even though the department that oversees the board, public health, knew by 2011 that Crosman was facing criminal charges, according to correspondence obtained by the Globe.

Home aides in Massachusetts do not need a license and, unlike in 17 other states, the FBI doesn’t check the backgrounds of agency workers.

State Representative Mathew Muratore, a Plymouth Republican, introduced a bill last year to license home care agencies and improve training and supervision of workers, but the session ended without it coming up for a vote.

“There are cracks in the system — judicial as well as licensing — that we have to deal with legislatively,” Muratore said.

Home care agencies in Massachusetts are mandated to perform criminal background checks on people they hire, which might have alerted them to past allegations against Crosman, even if she was not convicted. They’re also required to report employee misconduct to the Department of Public Health, which might have resulted in her losing her license.

-See the full Boston Globe article.

Julio Ramirez was behind bars awaiting trial last summer. There was just one problem: He wasn’t available to face his charges in court. Ramirez, an immigrant from Guatemala, had been arrested after a minor traffic accident in August. Police had charged him with driving under the influence, and the charge led to him being held in Boston by federal immigration officials, who were threatening to deport him.

Ramirez came to the United States 14 years ago fleeing persecution in Guatemala. He worked in construction, volunteered for community organizations, built a life.

Ramirez hadn’t been convicted, but he couldn’t clear his name either. Officers from Immigration and Customs Enforcement — the agency that was holding him — refused to take him to court to answer for the OUI charge. After a lawsuit filed by the American Civil Liberties Union of Massachusetts, ICE relented and took him to court, where he was ultimately acquitted of the drunken driving charge.

Ramirez’s case highlighted a major and overlooked issue. Many people who are held in ICE custody are awaiting trial on a charge in state court. But there is no guarantee they can keep the court date that might offer the only path out of detention. You can’t clear your name if you can’t go to court, and many of those held — no one knows how many — weren’t being allowed to go to court.

It’s an unfair Catch-22. And it’s about to change.

Under a deal recently struck by the state’s trial courts, the ACLU, public defenders, and the sheriffs of three counties, trial judges will now be able to order that defendants such as Ramirez be brought to court — so that they will be able to answer the charges that, in many cases, led to their incarceration to begin with. ICE has also agreed to cooperate.

The deal represents an unusual act of collaboration among many players in the criminal justice system.

“We had all these people come together because there was a sense of the importance of the cases we knew about,” said Matt Segal, legal director of the ACLU. “And there was a sense that the cases we knew about were only the tip of the iceberg.’’

Delivering detainees to court is just one part of a larger issue. ICE’s enforcement policies have become a huge issue throughout the court system. Many people in the system — such as Suffolk District Attorney Rachael Rollins — worry that immigrants are fearful to go to court for totally valid reasons, such as pursuing restraining orders.

Guaranteeing the right of incarcerated people to go to court is a victory for justice. But it’s only a first step in addressing overzealous immigration enforcement.

- See the full The Boston Globe column.

HelpSteps is a free web and app-​based system that connects individuals to health and human services available in Massachusetts, developed by Dr. Eric Fleegler, a physician in the division of Emergency Medicine at Boston Children’s Hospital. HelpSteps is a vehicle designed to combat the social determinants of health by making social and health services readily available. To better serve the residents of Boston, Boston Public Health Commission partnered with Boston Children’s Hospital and adopted HelpSteps as its information and referral resource. The tool is designed to cater to users’ needs by location, language, services, nearest bus routes and much more. Built on a database that includes information on over 11,000 programs, it purports to be the most comprehensive option for finding local health and social services.​  

 If you would like to subscribe to Helpsteps.com newsletter or attend an information ​session please contact: edasilva@bphc.org​.

-See the full Boston Public Health Commission post.
-Listen to the WBUR CommonHealth story, January 16, 2019.

This Massport program was created to alleviate the arrival and departure-related stress of traveling through Boston Logan for passengers and their companions who come to Boston for medical assistance. The Program offers the following:

• Prearranged personalized meet and greet services at the gate and through the airport concourses
• Foreign language interpretation services
• Expedited clearance through the Federal Inspection process- Customs and Border Protection
• Escort and assistance through TSA security check point
• General terminal wayfinding and passenger service assistance
• Ground transportation coordination
• Prompt luggage check-in and reclamation

Patients and family members are met and assisted by Customer Service staff members at their gate or departure level and escorted throughout the airport navigation process.

The service is available daily from 4:30am-11:30 pm (7 days a week).  48 hour notice is required for domestic requests and 72 hours for international requests. 

To request assistance complete the LAMPAP form and either fax to 617- 561-1866 or email to MSanchez@massport.com and meetandassist@massport.com. (For your convenience here are the MGH release of PHI forms: English and Spanish.)Weekend requests can also be faxed to the same number for processing by a weekend supervisory staff. 

The contact person for the program is Maritza Sanchez at 617-561-1803.

-Thank you to Sarah Taddei for sharing this resource.

Updated (3/24)

The MGH owned The Clubs at Charles River Park offers weekly memberships for MGH patients and families who are here for treatment, whether for an extended stay or periodic visits. Weekly memberships include access to all classes and equipment. Fees are $22.00 a week for an individual and $35.00 for a family of up to 5 people.

Adam Marks, Assistant Manager, Member Services, advises that no MGH referral is needed, patients and families can contact The Clubs directly (617-726-2900), and should request the “Hopes Membership” (the program originated under the Social Service Department/Cancer Center’s Hopes program, and that terminology is still used).

Advocates can contact Adam Marks at 617-726-7694 or via email at ACMarks@partners.org if additional advocacy is required.

- Thanks to Leslie Goodhue for the information and Adam Marks for his assistance with this article.

The YMCA of the North Shore is offering a new program that offers membership discounts, free summer camps and more for cancer patients, survivors, and their families. The Corner Stone program includes:

• A FREE YMCA membership to cancer survivors (those diagnosed within the past 5 years) and their families for one year (with extended options for those still receiving treatment)
• Access to a Corner Stone Navigator
• A complimentary week of summer camp for all children in the family enrolled in the program
• A schedule of special drop-in babysitting for parents who are currently in treatment
• Scheduling/classes modified for Cornerstone Program
• Discounted personal trainers
• Speakers/Presentations
• Cornerstone meet-ups: structured networking, support

See the schedule

YMCA of North Shore locations

• Ipswich
• Cape Ann
• Marblehead
• Beverly
• Gloucester
• Haverhill
• Plaistow, NH

Though the program is based on the North Shore, it is open to eligible residents of other communities.

To Enroll:

• Meet with Corner Stone Navigator for onboarding process
• Provide proof of eligibility 

More Information: https://www.northshoreymca.org/content/corner-stone

- Thanks to Devon Punch for sharing this information.

It may be the only way someone who needs the police — but has to remain as quiet as possible — can summon help. For the first time, cellphone users in Massachusetts can now send text messages directly to emergency dispatchers, a major upgrade to what is known as the Next Generation 911 system. The new service had a “soft rollout” in December and is now in place in call centers across the state, officials said.

The arrival of text messaging also marks a significant advance for the deaf and hard of hearing, who have had to connect to a text telephone system to contact emergency assistance, a process that required a landline, specialized equipment, or a third party, officials said.

Officials said that people should text 911 only when calling is not possible.

The Federal Communications Commission has pushed communities and cellphone providers to provide text-to-911 service nationwide, but fewer than 1,500 public safety agencies nationally do so.

Text exchanges with emergency dispatchers are the same as ordinary messages. The person needing help types 911 in the “to” or “recipient” field. The person is connected to a dispatcher who reads the message on the same dispatch screen used for other 911 calls, regardless of the technology. The dispatcher can then type a reply.

The person in need of assistance is advised to be precise, brief, and explicit. Here are some other tips.

• Text messages will usually be received by local 911 dispatchers. But they won’t necessarily know where you are, so texters should immediately provide their location.
• If possible, texters should be precise about their whereabouts, especially if they are unfamiliar with the area or driving through it. They should provide landmarks, cross streets, names of businesses, floor and apartment numbers, and exact location within a building.

Additional improvements have also been made to the emergency call system. In those areas where 911 calls had been received by State Police dispatchers before being sent to local police, they now go directly to local dispatchers, although officials said there is still room for improvement in the accuracy of call locations.

-See the full The Boston Globe article.

Addendum: Detailed flyer from Mass.gov

Effective January 1, 2019 the Centers for Medicare and Medicaid Services (CMS) requires all hospitals nationwide to establish, update and make available on the internet a list of their Standard Hospital Charges/Diagnosis Related Group Charges.

While the intent of CMS is to increase price transparency, this new regulation may create confusion for patients. As every insurer pays hospitals differently, the list of charges does not represent the true costs of care for patients – in fact, the costs are usually significantly less – and it is not a useful tool for patients who are evaluating costs of care. Clinicians and front-line staff may receive questions from patients about the charge lists and their accuracy.

Partners is working with all hospitals, including the MGH, to ensure they comply with this regulation and to ensure that patients have the appropriate channels to get accurate information about their health care costs. Most Partners hospitals will link to the Patient Billing and Financial Assistance section on http://www.partners.org. If a patient goes to the Partners site, they will be re-directed to the best way to request a cost estimate, which is to contact Patient Billing Solutions at 617-726-3884.

For help responding to patients with questions, please review the “Hospital Price Transparency QA” document on Partners Pulse. 

- Adapted from Daily Announcements, Broadcast MGH, January 03, 2019.

This guide is an updated and expanded version of 20 Common Nursing Home Problems – and How to Resolve Them, which was written with financial support from the Commonwealth Fund. This revision, like the original edition, introduces each common problem by identifying a false statement commonly made by nursing home staff, along with a clear statement of the relevant law.

The Nursing Home Reform Law

Federal nursing home law applies across the country, and is called the Nursing Home Reform Law. The Reform Law applies to every nursing home that is certified to accept payment from the Medicare or Medicaid programs (or both), even if the resident involved is not utilizing Medicare or Medicaid payment. Because Medicare and Medicaid are important sources of payment, almost all nursing homes are governed by the Reform Law.

The Reform Law's cornerstone is the requirement that each nursing home provide the care needed by a resident to reach the highest practicable level of functioning. Some residents are capable of gaining strength and function; other residents are capable of maintaining their current condition. Still other residents, at most, may be able to moderate their level of decline. In each of these situations, the nursing home must provide all necessary and appropriate care.

Where to Go for Help

In implementing this guide’s strategies, a resident or resident’s family member at times may benefit from the assistance of an attorney or other advocate. One good source of help can be the long-term care ombudsman program. Each state has an ombudsman program that provides advocacy for nursing home residents free-of-charge. Contact information for a particular state’s ombudsman program can be found at the website of the National Long Term Care Ombudsman Resource Center.

Guide topics include- problems with poor care, problems with evictions, Medicare-related problems, denial of resident rights and admission and billing problems.

The National Consumer Voice for Quality Long-Term Care website has many helpful publications for nursing home residents and their families. (See in particular the helpful advocate fact sheets.)

- See the full guide 25 Common Nursing Home Problems— & How to Resolve Them, from Justice in Aging.

The National Center on Law & Elder Rights (NCLER) has a created a new fact sheet Five Tips to Stop Abusive Debt Collection Practice.  

Excerpts:

• Obtain additional information about the collector and debt, and dispute invalid debts. Consumers should verify the legitimacy of the collector before disclosing personal or financial information over the telephone or agreeing to make payments. They can obtain the collector’s name and company information. In some states, they can check to see if the collector is licensed. If the consumer does not owe the debt, wants more information regarding the debt, or believes the amount owed is wrong, they may dispute the debt or request verification of the debt by sending a certified letter to the collector. If possible, this letter should be sent within 30 days of receiving the first written communication from the debt collector.
• Inform collectors that all income and property are exempt. Federal and state law protects certain income and property from seizure. This includes Social Security, SSI, veterans’ disability, unemployment, and workers’ compensation benefits. Consumers whose income and assets are protected should ask collectors to stop collection on the debt because they are “judgment proof ” and confirm the request in writing.
• Stop debt collection communication and harassment. The most direct strategy to stop collection harassment is to send a “stop contact” or “cease communication” letter. The collector will stop contacting the consumer except for a few contacts allowed by law. Even though the collector stops contacting the consumer, the debt is still owed and the collector may sue. Older adults should keep a careful record of telephone calls, letters, or other communication received after the letter is sent. This will be helpful if the consumer sues the debt collector or files a complaint. Complaints may be filed with the Consumer Financial Protection Bureau or state attorneys general.
• Consider filing for bankruptcy. Consumers who are financially over-extended should consult a bankruptcy attorney to discuss whether bankruptcy is appropriate for them.

Consumers may also employ other strategies such as negotiating with the original creditor or collector for a discounted payoff. It is helpful to offer a lump sum payment.

The federal Fair Debt Collection Practices Act (FDCPA) prohibits certain conduct, including:

• Communicating with consumers who mailed in a written cease communication request (some exceptions apply).

• Calling before 8:00 a.m. or after 9:00 p.m.
• Using obscene words, racial slurs, insulting remarks, or threats of violence.
• Stating that nonpayment will result in arrest, garnishment, or seizure of property or wages, unless such actions are lawful, and unless the collector fully intends to take such action.
• Creating the false impression that the collector is an affiliate or agent of the government.

- See the full guide: Five Tips to Stop Abusive Debt Collection Practice.  

Health Story Collaborative

Health Story Collaborative, founded by MGH’s Dr. Annie Brewster, is a series of programs whose mission is to keep the patient voice alive in healthcare. Dr. Brewster and her team collect patient stories of illness and healing to make the process of navigating illness less isolating and to empower families facing health challenges. The Health Story Collaborative contains four separate programs- the Audio Library, Healing Story Sessions, Healing Art Archive, and SharingClinic. The SharingClinic is an audio listening clinic in the Maxwell & Eleanor Blum Patient and Family Learning Center at MGH. This listening kiosk houses an array of audio clips of interviews with patients, patient’s loved ones, and healthcare providers.

For more information, see http://www.healthstorycollaborative.org/.  

As a reminder, those who are eligible for health insurance coverage that meets Minimum Essential Coverage (MEC) standards are not eligible for Health Connector subsidized coverage. This includes coverage through a job, spouse or partner, and public programs such as Medicare or MassHealth.

If an individual is found to be eligible for Medicare during the benefit year, they will lose eligibility for subsidies for the rest of the year.

As before, individuals eligible for Medicare but who do not already have coverage through the Health Connector cannot sign up for new coverage, including unsubsidized coverage. Now, due to updates in federal law, Medicare-eligible individuals may no longer renew their unsubsidized coverage through the Health Connector. 

As a result, Health Connector renewal policies have changed for 2019. Members who were identified as Medicare eligible during the 2019 redeterminations and renewals process: 

• Were able to remain enrolled in Health Connector health coverage (QHP) through the end of 2018 only, they could not renew their Health Connector coverage or change their 2018 plan.
• This change impacted both subsidized and unsubsidized Health Connector members
• These members were able to continue their enrollment in Dental plans
• These members may have been able to renew directly with their carrier, if the carrier offered the same policy or plan off the Exchange.

Please review the sample Medicare letter that was sent to members who have been found to be newly eligible for Medicare benefits. In addition to this letter, members have been notified in either their Preliminary Eligibility notice or their Final eligibility notice that they will no longer be eligible for Connector coverage in 2019.

What if other members of the household still need health insurance coverage?

If the subscriber of a plan becomes newly eligible for Medicare, there are important steps to take in order to maintain enrollment in coverage for the other household members enrolled with them. 

1. Members can login to their online account to update their application or call Health Connector Customer Service to report a change. 
2. Within the application, they should indicate that the newly Medicare eligible person no longer needs insurance coverage. 
3. Then re-shop for a plan for the household members that seek to continue Health Connector coverage.

For instructions and the impacts of making application changes visit: 
https://www.mahealthconnector.org/help-center-answers/reporting-changes

Where to get help with understanding Medicare options

For MGH sites without access to Patient Financial Services, individuals and families can get free help with understanding Medicare through the SHINE Program (Serving the Health Insurance Needs of Everyone). To make an appointment with a counselor call: 1- 800-AGE-INFO (1-800-243-4636) and press 3. Individuals can also call their town's Council on Aging for help.

Enrolling in Medicare

If someone hasn't enrolled in Medicare yet, The Connector recommends that they do this as soon as possible. If they don't sign up during their Initial Enrollment Period for Medicare, they could end up paying a late enrollment penalty later on.

They can contact the Social Security Administration at 1-800-772-1213 for help with enrolling. Learn more about the Initial Enrollment Period and find more information about Medicare by visiting: Medicare.gov

If they already face a late penalty or lock-out of Medicare due to failure to enroll in Medicare on time, they should contact the SHINE Program for assistance with Equitable Relief.

Please review the detailed talking points for SHINE counselors for more information.

- Adapted from Helping Health Connector households with members who are newly eligible for Medicare, MA Health Care Training Forum, January 23, 2019.

While Medicare Part D covers your prescription drugs in most cases, there are circumstances where your drugs are covered under either Part A or Part B.

Part A covers the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility (SNF).

Note: If you are getting SNF care that is not covered by Part A, your drugs may be covered by Part D.

Part B covers most drugs administered by your provider or at a dialysis facility, but the provider or facility must buy and supply the drugs. Part B also covers some outpatient prescription drugs, mainly certain oral cancer drugs (chemotherapy). Outpatient drugs previously paid for by Part B will continue to be paid for by Part B. Part D cannot pay for any of your drugs that are covered by Part B.

Part D covers most outpatient prescription drugs (drugs you fill at a pharmacy). Check your plan’s formulary to find out whether it covers the drugs you need.

Note: There are a few drugs that can be covered by either Part B or Part D depending on the circumstances.

- From Administrative Proposal to Lower Medicare Drug Prices Shows Promise but Risks Remain, Medicare Watch, The Medicare Rights Center, January 03, 2019.

Medicare has finished mailing new Medicare cards to all beneficiaries. You can still use your old card to get your care covered until January 1, 2020. However, if you have not received your new card, you should call 1-800-MEDICARE (633-4227) and speak to a representative. 

If you are enrolled in a Part D plan (Medicare prescription drug benefit), you will use the Part D plan’s card at the pharmacy.

If you are enrolled in a Medicare Advantage Plan (like an HMO, PPO, or PFFS), you will not use the red, white, and blue card when you go to the doctor or hospital. Instead, you will use your Medicare Advantage Plan card, which you should receive in the mail. You will also use this card at the pharmacy if your plan serves as your Part D coverage. If you have a supplemental insurance plan, like a retiree or union plan, make sure to show that plan’s card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.

Your Medicare card, Social Security card, and other health insurance cards are very important documents. Make sure to keep a photocopy of your important identification and insurance cards, write down any important numbers (like your Medicare number), and keep everything in a safe place so that you have a record for future reference if anything gets lost. If your card is ever lost, stolen, or damaged, you can get a replacement card by calling 1-800-MEDICARE (633-4227). You can also order or print a card by logging in to your mymedicare.gov account.

Remember: Do not give your Medicare or Social Security numbers or personal data to strangers. Medicare will never ask for this information over the phone. If you believe you have been the target of Medicare marketing or billing fraud, contact your local Senior Medicare Patrol.

- From CMS Completes Rollout of New Medicare Cards Ahead of Schedule, Medicare Watch, The Medicare Rights Center, January 24, 2019.

Time is of the essence for Mary Napolitano. The Somerville resident starts each month with $900 in Social Security income. Subtract $545 for rent and heat. Subtract a little more ($55) for her monthly MBTA bus fare, and another $70 for uncovered medications and copayments. The bills add up, and Napolitano has $230 in expendable income by the end.

Napolitano is almost 64 years old, and she dreads turning 65, when she will no longer be eligible for MassHealth and under current rules won’t be eligible for a Medicare program that would keep her medical bills in check.

Advocates describe Napolitano’s situation as “falling off the cliff” – the time when her age, her income, and her assets combine to plunge her into an abyss between two government health care programs. (All numbers in this story are for single persons.)

MassHealth cuts people loose when they turn 65 if they have more than $2,000 in assets or a life insurance policy. Napolitano has a life insurance policy, so that would make her ineligible for MassHealth.

The Medicare program, called Medicare Savings, is a 53-year-old initiative that assists low-income seniors over 65 with copays, premiums, deductibles, and prescription coverage. It covers Medicare Part B Premium (at $135.50 per month) and automatically enrolls members in the federal Extra Help program, which helps cover deductibles, medications, and additional expenses.

To qualify for Medicare Savings in Massachusetts, a person must have income below 135 percent of the federal poverty level, or less than $16,400. Napolitano would meet that qualification, since her income is just $900.

But the Medicare program also has an asset threshold. Anyone with assets greater than $7,560, including life insurance, is ineligible. That’s where Napolitano falls off the cliff.

Twelve states including Mississippi and Alabama, have passed laws expanding access to Medicare Savings since the inception of the program in 1988. Massachusetts has not, so when Napolitano heard that Gov. Charlie Baker’s fiscal year 2020 budget includes a proposal expanding eligibility for Medicare Savings, she considered it a tentative godsend.

Legislation to expand eligibility for Medicare Savings was filed originally in 2015, but it failed to make it through hurdles in the last two legislative sessions. Baker’s proposal would allow seniors with an income up to $20,000 per year (165 percent of the federal poverty level) to be eligible. The current limit is $16,400 (135 percent of the federal poverty level). He would no longer include life insurance policies in the equation.

An additional 25,000 seniors would be eligible to join the program, with 15,000 more having expanded assistance. The $10 million proposed as new state investment in the program would trigger over $100 million in federal funds.

The Massachusetts Senior Action Council doesn’t want to stop at 165 percent of the federal poverty level; the group wants to go to 200 percent over three years. The 200 percent federal poverty level expansion in the legislation Mass Senior Action Council just filed with lead sponsors Sen. Jason Lewis of Winchester and Rep. Steven Ultrino of Malden would completely close the eligibility gap between Connector Care and the Medicare Savings Program.

It would broaden the impact of Medicare Savings Programs beyond the 40,000 helped by the governor’s budget to 70,000 seniors.

Nationally, Massachusetts is among the states with the greatest percentage of economically insecure elders, second only to Mississippi. Sen. Brendan Crighton of Lynn doesn’t like to be compared to Mississippi. “I don’t want us to be included with Mississippi on any policy, especially for our seniors,” he said. “The governor has made a good start. We have to get to the full amount.”

- See the full Commonwealth magazine story.

Physicians from across the state at the Massachusetts Medical Society 2018 Interim Meeting, held Nov. 30 and Dec. 1, considered resolutions proposed by members to the organization’s House of Delegates, the medical society’s governing body. Resolutions that were accepted by the House of Delegates are now organizational policy. 

The adopted policies include one on immigration:

The Massachusetts Medical Society will advocate for safe access to health care for immigrants and refugees in the Commonwealth regardless of immigration status, advocate for and support legislative efforts to designate healthcare facilities as sensitive locations by law.  MMS will work with appropriate stakeholders to educate medical providers on the rights of undocumented patients while receiving medical care, and the designation of health care facilities as sensitive locations where US immigration enforcement actions should not occur. The medical society will encourage health care facilities to clearly demonstrate and promote their status as sensitive locations, and oppose the presence of immigration enforcement agents at health care facilities.

-See the full press release.

The American Medical Association Journal of Ethics has dedicated its January 2019 issue to "Health Care for Undocumented Immigrants". The issue considers the nature and scope of clinicians' obligations to support and care for undocumented immigrants, refugees, and asylees.

Articles include (not a complete list):

• Should Immigration Status Information Be Included in a Patient’s Health Record?
• Should Immigration Status Information Be Considered Protected Health Information?
• How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?
• Best Practices for Teaching Care Management of Undocumented Patients
• Resources for Teaching and Learning About Immigrant Health Care in Health Professions Education
• AMA Policies and Code of Medical Ethics’ Opinions Related to Health Care for Patients Who Are Immigrants, Refugees, or Asylees
• Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients?

Read the entire publication at https://journalofethics.ama-assn.org/issue/health-care-undocumented-immigrants

- From AMA Journal of Ethics January 2019, Health & Law Immigrant Solidarity Network (HLISN) Listserv, on behalf of Vonessa Costa, January 10, 2019.

Privately insured patients have been asked to rate their medical providers for years. Now, for the first time, Massachusetts is seeking the opinions of thousands of Medicaid recipients about their experiences in the doctor’s office.

Beginning this month, nearly 250,000 low-income and disabled patients will be asked questions such as whether they or their children were able to get appointments when they needed them, whether doctors and office staff communicated respectfully, and whether their mental health treatment actually improved their ability to work or attend school.

The results will give state officials a window into how well Medicaid providers care for patients amid a significant restructuring of the program. And the information will allow the state to direct higher payments to better performers. Eventually, officials plan to publicly release some results, allowing Medicaid recipients to compare the quality of provider networks.

The state plans to make results of the 2019 “patient experience’’ survey public in early 2020, Sharon Torgerson, agency spokeswoman, said in an e-mail. But the public information will not be as detailed as it is for privately insured residents, and some say the state should go further to address this disparity.

The nationwide movement to make the cost and quality of health care more transparent has largely bypassed state Medicaid programs. Little is known about how well Medicaid providers do their jobs, despite the immensity of these programs.

“This is really groundbreaking work on the part of the state,’’ said Barbra Rabson, president of Massachusetts Health Quality Partners, a nonprofit group the state has hired to conduct the survey. But, she said, “it is one small piece of a very big puzzle.’’

MassHealth signed a $4.4 million three-year contract with the group, which will survey MassHealth members enrolled in one of 17 newly formed “accountable care organizations’’ — networks of doctors and hospitals that work to tightly manage patients’ care. The focus will be on primary care, behavioral health care, and long-term services and support, such as speech and occupational therapy.

MassHeath will make public quality data about each of the 17 accountable care organizations. Each one includes many primary care practices. The more detailed the survey, the more expensive it is — and potentially the more useful to patients.

The state’s primary goal is “to hold [these organizations] financially accountable for member experience,’’ Torgerson said.

The member satisfaction survey was not necessarily intended to help recipients choose providers, state officials said. But they said they will evaluate releasing more detailed data in future years.

- See the full The Boston Globe article.

The average price of insulin nearly tripled between 2002 and 2013, according to the American Diabetes Association. The cost of a single vial of insulin varies, but patients with insurance can pay as much as $300 for one that may only last a week or two. A 2018 study showed that the cost of insulin results in nearly 25 percent of all patients adjusting their prescription. Because of the high cost, some people with diabetes are rationing their insulin — taking less than they should to make the supply last longer.

Patients may also turn to the black market to buy insulin at cheaper prices than drug stores. Some drive to Canada, while others share expired insulin through an online medical community. They lay blame for all of this on drug makers who, they say, put profit over patients.

In November, a coalition of activists, including the mothers of two children with diabetes who died while rationing insulin, protested the high costs of insulin outside the Cambridge offices of Sanofi, one of three major drug companies manufacturing the drug. The other two are Eli Lilly and Company and Novo Nordisk.

WGBH News reached out to Sanofi about rising insulin prices. The company sent a video and a statement saying it's exploring ways to reduce out of pocket expenses, including expanding a program that offers "qualifying patients the opportunity to obtain two of Sanofi's insulins at a set price" of $99 for a 10 milliliter vial. Since April, more than 6,500 people have enrolled in the program.

However, critics note that there are more than 30 million people — almost 10 percent of the entire U.S. population — living with diabetes in America. The income cap on the savings program means large numbers of uninsured and underinsured people still don't have access to affordable diabetes medications, they argue.

Dr. Rob Gabbay, chief medical officer of Boston’s Joslin Diabetes Center, said setting the price of insulin is complicated and not easily understood. He said it involves pharmaceutical companies, benefit managers and payers, and that’s why he’s recommending greater transparency in pharmaceutical price setting.

“There are a number of different players in the supply chain,” Gabbay said. "Each of them have the potential for a markup, and we don’t know where that really is."

- See the full WGBH story.

Federal lawmakers from Massachusetts are criticizing Columbia Gas about backdated gas bills being sent to Merrimack Valley residents and a winter rate hike, months after explosions and fires rocked the region.

In a statement, a Columbia gas spokesman, Scott Ferson, said that customers whose natural gas appliances were not repaired or replaced and whose gas service was turned off as a precaution in the aftermath of Sept. 13 recently received gas bills for the first time since the fires.

Those customers, according to the utility, received a full month’s “restoration credit” for any and all months in which they did not receive service for one or more days.

“We delayed billing everyone in the affected area immediately after the event so that our customers — like the company — could focus on restoration,” Ferson said. “We sincerely apologize for the confusion this may have caused.”

Customers whose natural gas appliances were repaired or replaced will not be billed for gas service from the date of the catastrophe through the end of December, according to Ferson. Billing, he said, will resume this month, and such customers will receive their first bill next month, a bill that might include any balances that existed prior to Sept. 13.

Customers who are having problems paying their bills are encouraged to call a customer line at 1-866-388-3239.

- See the full The Boston Globe article.

The Massachusetts minimum wage increased to $12 effective January 2, 2019.  Mass. Law Reform Institute (MLRI) has received questions about whether this increase in household wages will trigger a dramatic loss of SNAP benefits and/or free school meal status. The answer is for most is no. Here's what you need to know: 

1. Most SNAP households remain SNAP eligible even with the January wage increase. As long as gross income is below 200% FPL, most households will qualify for some SNAP depending on shelter costs and child care. As a general rule, for every $3 in net countable income, SNAP benefits decrease by approximately $1. The attached chart shows some sample calculations of benefits based on how much a household gets based on hourly wages and work hours and with varying deductions.
2. Do families need to report increased earnings to DTA?  SNAP households on simplified reporting do not need to report the increased wages until their next Interim Report or Recert, unless their total gross income exceeds 200% of the FPL. Different reporting rules apply for TAFDC or EAEDC cash assistance households. 
3. HIP and other benefits: All SNAP households still qualify for the Healthy Incentives Program (HIP) benefits at the maximum HIP amounts, regardless of the amount of monthly SNAP.  And all SNAP households still qualify for other discounts like the Mass Culture Card discounts, utility discounts and more. See MLRI’s infographic flier, the Added Benefits of SNAP (available in five languages).
4. Free school meals: Any child that receives SNAP, or lives with a child that receives SNAP, still qualifies for free school meal status, even if the family only gets a small amount of SNAP. And children who receive either TAFDC or MassHealth (gross income below 133% FPL) also qualify for free meal status. That also includes any children who live with that recipient child. Families getting free or reduced-price meal status through the National School Lunch Program application do not need to report the change until filing a NSLP application at the start of the new school year (August or September 2019).
5. Impact on work requirements for ABAWDs: With the increase in the minimum wage, the minimum earnings or number of required community service hours a non-exempt childless adult or "ABAWD" needs to do to keep SNAP after 3 months is less. If the ABAWD receives the maximum of $192/mo in SNAP and does not have paid work, the required "community service" hours per month is now 16 hours/month (about 4 hours/week). 

- Adapted from Will the MA Minimum Wage to $12 Create a "Cliff Effect" for Working Families? NO!, FoodSNAPCoalition listserv on behalf of Pat Baker, MLRI, January 02, 2019.

There's a message public health leaders aim to spread far and wide. An April advisory from the U.S. surgeon general summarized it as "BE PREPARED. GET NALOXONE. SAVE A LIFE."

But life insurers consider the use of prescription drugs when reviewing policy applicants. And it can be difficult to tell the difference between someone who carries naloxone to save others and someone who carries naloxone because they are at risk for an overdose.

Massachusetts U.S. Sen. Ed Markey is asking two national organizations that deal with life insurance for details about companies that deny coverage to applicants who carry naloxone, often sold as Narcan, the drug that reverses an opioid overdose.

Markey's letter comes in response to a recent WBUR story about a nurse at Boston Medical Center who was denied coverage from two different insurers because she carries naloxone to serve as a good Samaritan. She's reapplied for coverage with the second insurer.

BMC has alerted the state Division of Insurance, which said in a statement it is reviewing the cases and drafting guidelines for “the reasonable use of drug history information in determining whether to issue a life insurance policy.”

"I am concerned that if [G]ood Samaritans are denied insurance coverage because they carry naloxone to promote public health and safety, this will have a chilling effect on efforts to make naloxone widely available and accessible, and will ultimately cost lives," Markey said in a letter  to the National Association of Insurance Commissioners (NAIC) and the American Council of Life Insurers (ACLI).

The letter includes a number of questions: How do insurers determine if an applicant is prescribed naloxone because they are at risk for an overdose, or to save others; how often have applicants been denied life insurance for carrying naloxone; and whether there are guidelines to prevent wrongful denials.

The letter also asks whether life insurers are aware that most states (including Massachusetts) have issued what's known as a standing order for naloxone, meaning one prescription that works for anyone who wants to buy naloxone at their local pharmacy.

Dr. Alex Walley, the Boston-based physician who signs that order for everyone in Massachusetts, has been asked to write letters for about half a dozen life insurance applicants explaining why they carry naloxone. He says he can't answer whether the applicants do or do not use drugs.

"I can't do that, they're not my patients, I haven't examined them, I don't know their status," Walley said. "I think in a lot of a cases the insurance companies don't exactly understand the situation, they're not plugged into state policy and what a pharmacy standing order is."

Both the NAIC and the ACLI said they had received the letter and will review it.

- See the WBUR stories:

• Why You May Be Denied Life Insurance For Carrying Naloxone
• Markey Demands Details About Life Insurance Denials For Carrying Naloxone

Part of a series of occasional articles on how money affects patients and their care- the “Unhealthy Divide”. Read more.

Cancer is a tremendous burden on anyone. But for a growing number of lower-income and even middle-class patients, a diagnosis leads to an avalanche of trouble.

Medical science has a name for the damaging economic side effects of serious illness — “financial toxicity.”

Health insurance does not always provide protection — one-third of cancer patients go into debt, most owe more than $10,000 — because their policies do not cover all the treatments and medications they need. Low-wage, hourly workers with little savings and paid time off, however, are especially vulnerable. House cleaners, cashiers, bus drivers, nursing home aides, and many others.

“If you are living on the brink, even the smallest shock is going to push you over the edge,’’ said Dr. Megan Sandel, a pediatrician at Boston Medical Center. “And a cancer diagnosis is a major shock.’’

Even in Massachusetts, a state that enjoys one of the highest average household incomes and lowest percent of uninsured residents in the country, this scenario plays out repeatedly.

Across the city from Boston Medical Center, Dr. Kira Bona studied 100 families whose children were treated for cancer at Dana-Farber Cancer Institute between 2011 and 2013. Over the first six months of chemotherapy, the number of families with unstable housing — meaning they were doubled-up with other families, living in overcrowded conditions, or had moved multiple times — rose from three to seven, and the number of families without enough food jumped from 11 to 19.

However rich in resources, the state still has no comprehensive approach to cancer’s financial toxicity. Doctors often aren’t even aware that a patient is struggling financially. Some charities and foundations provide assistance, but the need is great and they generally offer just one or two rent or mortgage payments.

As for lower-income housing, here is a startling statistic. Metro Housing Boston, which helps lower-income residents pay rent, has 36,000 people on its waiting list for so-called Section 8 vouchers. Those at the top of the list applied in 2007. The group does not offer special status for applicants with major illness. Neither does the Boston Housing Authority, where the wait for a unit can stretch a decade.

“There is no real good answer here,” said Katherine Sharpe, senior vice president for patient and caregiver support at the American Cancer Society. “We try to match what resources are available to patients. This is definitely a gap.”

- See the full The Boston Globe article (including quotes from former CRC General Resource Specialist, and now American Cancer Society Patient Navigator, Lindsey Streahle.)

Although Massachusetts has some of the country's top health care providers, that health care is not always accessible to residents -- especially those seeking care for mental health or substance use disorders, according to a new study released by the Blue Cross Blue Shield of Massachusetts Foundation. 

The study found that the lack of available care means people with mental health problems or substance use disorders end up going without care or end up in the emergency room for problems that would have been treatable elsewhere, in a less expensive setting.

"I think it's also not hard to anticipate that if people need mental health and substance use disorder care and they can't get it, and they don't get it, then conditions can exacerbate and result in the need for a more significant treatment level and more expensive treatment," said Audrey Shelto, the foundation’s president.

The look at mental health care was part of a broader report on health care access. This is the first year the survey has asked about access to mental health care specifically. While people reported difficulty obtaining all kinds of health care, the unmet need was highest for mental health and substance use care.

The unmet need was not due to a lack of contact with the health system. Those seeking mental health care generally had insurance coverage and had a place they would typically go for medical care.

"It is clear that health insurance does not guarantee access" to mental health and substance use care, the report said. Previous studies have found that 45 percent of Massachusetts mental health providers refuse to take MassHealth, 38 percent will not take Medicare, and 16 percent will not take commercial insurance.

Providers may shy away from public insurance programs because of their low reimbursement rates and administrative hassle.

The study suggests that the difficulties are due to insurance reasons, a lack of providers in some geographic areas and the "fragmented" system that provides mental health care. 

The foundation is launching a four-year grant program to create more urgent care centers for behavioral health care. Foundation officials have also been talking to state officials about ways to make the administrative process easier for providers willing to take public insurance.

- See the full Masslive article.

Seven states, including Maine and New Hampshire (the others being Arkansas, Indiana, Kentucky, Michigan, and Wisconsin), have approval from the Trump Administration to take Medicaid coverage away from people who don’t meet work requirements, with additional proposals pending. Specifics vary, but all work requirements will have the unintended consequences of taking coverage away from people who are already working or who should be exempt from the requirement based on disability or chronic illness. Moreover, Medicaid work requirements will not increase employment or improve health outcomes, contrary to the Administration’s claims.

In Arkansas, the only state so far to implement work requirements for Medicaid, it’s increasingly clear that the policy is also failing on its own terms. Far more Arkansans are losing Medicaid coverage than are in the presumed target group of people not working and ineligible for exemptions, which means people who should remain eligible are losing coverage. Moreover, the work requirement isn’t promoting employment. While many Arkansas Medicaid beneficiaries are working, only a tiny percentage of those subject to the requirements — 0.5 percent in the latest month’s report — have newly reported work hours in response to the work requirement. And even many of those beneficiaries might have found jobs without the new policy or might have already been working.

Work requirement policies can’t be fixed for several reasons. First, any work requirement will have the unintended consequence of taking coverage away from people who are already working or should be exempt due to illness, disability, or other factors. That’s because rules for reporting and claiming exemptions increase paperwork and red tape, which cause eligible people to lose coverage and become uninsured. Efforts to inform beneficiaries of the complex compliance requirements and the processes for reporting and claiming exemptions are certain to fall short, leaving people without the information and help they need to comply. In addition, working Medicaid beneficiaries often have low-wage jobs with volatile hours and little flexibility, so they may not be able to work a set number of hours each month — meaning that even people strongly attached to the labor force will lose coverage.

Second, work requirements are ineffective in promoting employment because they don’t accurately identify those who can work but aren’t working (often for reasons beyond their control), nor do they assess their needs or provide them with supports. And they can undermine work when people can’t get the health care they need to work or look for a job. Experience from the Temporary Assistance for Needy Families (TANF) program shows work requirements don’t significantly increase long-term employment and don’t reduce poverty. That’s even more likely the case with Medicaid: while TANF programs generally provide for at least some (albeit inadequate) supportive services that many low-income adults need in order to work, such as child care, job training, and transportation assistance, states implementing Medicaid work requirements aren’t required to provide any of that help.

Moreover, Medicaid is itself a work support. It makes affordable health coverage available to low-wage workers whose jobs don’t offer it and makes it possible for people with diabetes and other chronic illnesses to work by helping them control these conditions. Recent news reports from Arkansas provide stark evidence of how Medicaid work requirements can undermine their purported goals, including a profile of a working beneficiary who lost his coverage due to reporting difficulties, couldn’t get his medications, and ended up losing his job because he couldn’t afford to keep his chronic illness in check.

- See the full Center on Budget and Policy Priorities (CPBB) report.

Effective January 1, 2019, the Massachusetts Behavioral Health Partnership (MBHP) now covers Repetitive Transcranial Magnetic Stimulation (rTMS) for MassHealth members who receive their behavioral health benefits through MBHP. This applies to all members enrolled in MBHP, including those also enrolled with Community Care Cooperative (C3), Partners Healthcare Choice, Steward Health Choice plans, and the Primary Care Clinician (PCC) Plan. 

rTMS is a noninvasive method of brain stimulation using Magnetic Resonance Imaging (MRI)-strength magnetic field pulses. This procedure is a U.S. Food and Drug Administration (FDA) approved method for the treatment of resistant major depression.

If you have questions about submitting claims to MBHP, please contact MBHP's Community Relations Department at 1-800-495-0086 (press 1 for the English menu or 2 for the Spanish menu, then 3 then 1 to skip prompts), Monday through Thursday from 8:00 a.m. to 5:00 p.m., and on Fridays from 9:30 a.m. to 5:00 p.m.
 
- From 2 Customer Service, Manage Claims and Payment Notices - Wednesday, 12/26/2018, MA Health Care Training Forum.