 |
MGH Community News |
|
MGH Community News |
| February 2020 | Volume 24 • Issue 2 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
New Social Security Disability Rules Effective April 27, 2020 As reported in December (Trump Proposes Social Security Change That Could End Disability Benefits for Hundreds of Thousands), the Republican administration has proposed increasing the reporting requirements for those receiving disability payments. The Social Security Administration has announced that the new rule will be effective April 27, 2020. It increases the continuing disability review (CDR) frequency for both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). SSA is proposing creating a new category under its existing Continuing Disability Reviews (CDRs) system, which is designed to ensure that people who receive benefits need those benefits due to a disability that affects their ability to work. CDRs are typically handled via a set of forms that need to be mailed in or a full medical review. A review requires significant documentation as well as a physical exam by doctors contracting with SSA to determine if a person's disability has in fact improved. The frequency with which a beneficiary is reviewed can vary depending on the severity of the person's condition and the likelihood that an individual would be able to work with said diagnosis.
There are three categories that are used: "medical improvement expected" (varies between once every six months and once every 18 months), "medical improvement possible" (once every three years) and "medical improvement not expected" (once every seven years.) The category will include about 4.4 million who are already in the Social Security system, as outlined in the proposed rule would also include those between 50-65 who live with a combination of different disabilities and chronic illnesses that make it extremely difficult to work, and people with targeted disease diagnoses, such as cancer survivors and transplant recipients. |
The rule would make the CDR process so burdensome with its frequency and layers of bureaucracy that people will either be disqualified, or fall out of the process due to its difficulty. It requires them to pull all their medical paperwork together, and get it updated to demonstrate that they still need benefits. For many, this requires going to specialists, getting lab work or other tests that are required to demonstrate evidence of diagnosis. For those on limited incomes, as most people on SSI and SSDI are, it may require increased transportation costs, or costs associated with procuring copies of medical files. Having to do this every two years will be expensive for folks already living at the margins. What's more, as it is, Social Security does not have the bandwidth to process existing applications, with 10,000 people dying a year waiting for approval. This process is likely to be strung out even more, with an additional 2.6 million reviews to conduct over the next 10 years, as stated in the proposed rule. The new category review is expected to come in two forms, one as a postcard, and one as a complex 15-page document with essay questions that would require an individual to maintain a robust and extremely detailed set of personal medical records. It is important to note that this form will be only available in English, as per a previous Notice of Proposed Rulemaking. So those people for whom English is a second language and had previously applied in the existing categories using a form that was available in their native tongue, this would no longer be the case. Furthermore, individuals who do not have consistent housing or medical care are significantly less likely to have access to the type of paperwork because they are less likely to have a secure, dry place to maintain paper records and are less likely to receive the regular and specialized medical care required to complete this form accurately. - See the full SSA blog post and the full CNN story
Voting for Hospitalized Patients The Massachusetts presidential primary is Tuesday March 3, 2020. Last Minute Voting If a Massachusetts voter has entered a health care facility anytime after twelve o’clock noon of the 5th day before the election, contact the city or town clerk about the proper procedure to be followed (will vary) for last minute absentee voting. We been informed that New Hampshire does not have a procedure for last-minute absentee voting, but potential voters/their families may want to confirm: Phone: 603-271-3242, email: elections@sos.state.nh.us
Public Charge Rule Goes into Effect A new rule that imposes a wealth test on green card and visa applicants took effect Monday, February 24, 2020, and across Massachusetts, advocates are concerned about what this could mean for immigrants. Although the U.S. Supreme Court has lifted all remaining injunctions blocking the rule, litigation continues in courts across the country. Under the change, immigrants who want to apply for a green card, or lawful permanent residence, or a visa to enter the US will have to pass a test that poses a litany of new questions about income and benefits to be submitted to US Citizenship and Immigration Services. Immigration services will review all of the person’s circumstances, including their age, income, health, education, English language skills, and sponsor’s affidavit of support. The government will also consider whether a person has used certain public programs, like the Supplemental Nutritional Assistance program (food stamps), federal public housing and Section 8 vouchers, Medicaid, (except for emergency services, children under 21 years, pregnant women and new mothers), and any cash assistance programs like Social Security income. If immigration services concludes that a green card applicant might be on public assistance in the future, that would also be grounds to deny legal status. Advocates say most people subject to the new rule are not eligible for the above listed benefits, and should keep in mind that food banks, state and local health care programs, school lunches, the federal insurance program covering low-income children, and the Women, Infants, and Children nutrition program don’t count either. Advocates say a big concern is the broad range of incomes that will be grounds for potential rejection by immigration officials. Anyone with income under 250 percent of the federal poverty level, or $65,000 for a family of four, will be subject to scrutiny. “Overnight, eligibility for green cards has been dramatically reduced,” said Marion Davis, spokeswoman for Massachusetts Immigrant and Refugee Advocacy coalition. The rule change would impact anyone in the US seeking a green card through a family petition, including anyone who is the child, spouse, or family member of a US citizen. A new document called an I-944 will used by the Department of Homeland Security to have individuals applying for legal status explain their ability to maintain self-sufficiency.
Questions about health insurance, including details on premium costs and deductibles, are included. Previously, only proof of insurance was needed for the process. The controversial new rule will not affect immigrants in the middle of removal proceedings, which includes a little less than 40,000 people in Massachusetts. It also does not apply to individuals seeking to adjust their status as refugees, asylum recipients, domestic violence visa beneficiaries, or those immigrants who have applied for a visa as victims of crimes (a U-visa). Messaging Advocates are concerned some immigrants may believe they need to unenroll from public programs that they or their children qualify for out of concern with how that information could be used against them in the future. “We don’t want to scare people,” said Andrew Cohen, a staff attorney for Health Law Advocates. “But just because the benefits they have aren’t going to be a problem doesn’t mean they’re going to be safe, because if they’re poor, they can still be denied a green card.” As part of a nationwide “teach-in” day organized by the Protecting Immigrant Families campaign, MIRA and its PIF co-leaders in Massachusetts – Health Care for All, Health Law Advocates and the Mass. Law Reform Institute – organized a discussion with more than 60 immigrant leaders and service providers on Monday, hosted by the Boston Mayor’s Office for Immigrant Advancement.
Mario Paredes, staff attorney at MLRI, explained the test applies only to people seeking a green card or a non-immigrant visa, not those who already have green cards. Several categories of applicants are also exempt, including refugees, asylees, U and T visas, and self-petitioners under the Violence Against Women Act. Based on federal officials’ statements, “we were thinking that this rule would be all about benefits before it came out,” said Andrew Cohen, supervising attorney at Health Law Advocates. “What we saw with the real text of the rule is that it’s much more about penalizing poverty.” That said, the rule does list specific programs that, if used after today, will be counted against an applicant. Given the enormous chilling effect that has had on immigrants, Cohen explained in detail which health programs are exempt, including MassHealth coverage for children under 21 and pregnant women, the Health Safety Net, MassHealth Limited and coverage through the Health Connector. Those happen to be the programs that green card applicants are likeliest to have used, whereas very few would even be eligible for the coverage that would count against them. In the discussion after the presentations, speaker after speaker expressed concern that immigrants don’t know that those programs are exempt – or that benefits received by their children don’t count, either. And while advocates and health care providers can advise them and deter them from dropping out of programs, they can’t reach people who simply stop going to the doctor, or quietly withdraw or choose not to sign up for benefits. “There is a lot of misinformation out there,” said Bethany Li, of Greater Boston Legal Services. María González Albuixech, director of communications and immigrant health at Health Care For All, explained how her organization’s HelpLine is screening immigrants to determine whether they’re subject to the “public charge” test, so it can distinguish those who are “totally safe” – the majority – and those who need to be referred to an immigration lawyer.
Mahsa Khanbabai, New England Chapter chair of the American Immigration Lawyers Association, said immigration officers in New England have not even received guidance on the new rule yet, or been trained to apply it. See the MIRA Resource Library. The MIRA Resource Library includes the following MIRA-authored, MA specific, resources:
- Sources and for more information:
Patients with Chronic Health Conditions May be Being Inappropriately Discharged from Home Health After Recent Medicare Changes A new article from Kaiser Health News (KHN), “What To Do If Your Home Health Care Agency Ditches You,” shines a light on confusion regarding recent changes to Medicare home health payments and beneficiary access to those services. The article shares the experience of Medicare beneficiaries Craig Holly and his wife, Effie Costas-Holly. Effie has advanced multiple sclerosis and was receiving a relatively minimal amount of home health care. The agency abruptly ended her services last month and told Craig this was due to Medicare’s new home health payment system. While CMS did adopt a new payment structure on January 1, known as the Patient-Driven Groupings Model (PDGM), the underlying benefit and coverage rules were not affected. All that changed is how Original Medicare pays home health agencies. Under the old system, Medicare’s home health rates reflected the amount of therapy delivered, so that more visits meant higher payments. Under the PDGM, therapy isn’t explicitly factored into the reimbursements. Instead, payments are based on several factors that result in agencies being paid higher rates for serving beneficiaries who require complex nursing care and lower rates for providing care to people with long-term chronic conditions. Such financial incentives would seem to put those who need lower amounts of care at risk. In response to this concern, CMS said that it does “not expect home health agencies to under-supply care or services; reduce the number of visits in response to payment; or inappropriately discharge a patient receiving Medicare home health services as these would be violations of [Medicare] conditions of participation.” However, reports suggest that is indeed happening. Further, the article notes that “therapists, home health agencies and association leaders say that patients across the country are being told they no longer qualify for certain services…or that services have to be cut back or discontinued.” Since home health agency confusion appears to be widespread, the KHN article outlines steps people can take if they find themselves in such a situation. The recommendations include getting as much information from the agency as possible, enlisting the assistance of the physician who ordered the home health care services, and reaching out to 1-8000-Medicare and consumer advocates for help. If you are experiencing a coverage disruption or have questions, counselors at Medicare Rights’ National Helpline are available Monday through Friday at 800-333-4114. Read the article, “What To Do If Your Home Health Care Agency Ditches You.” - See the full Medicare Rights Center blog post.
Baker Signs Law Creating Caregiver Abuse Registry Nicky Chan was attending a day program for people with intellectual disabilities when he was beaten by a caregiver. The caregiver was found not guilty in court, and there was no way to ensure the caregiver would not get a job at another program. Statistically, abuse of people with disabilities is rarely charged in court for a range of reasons. Victims may be nonverbal, their memories may be unreliable by the time an incident is reported, or they may face pressure from a place where they receive services not to testify. According to the bill’s sponsors, 26 states have registries to track individuals who abuse people with disabilities, based on agency investigations rather than criminal convictions. This month, Gov. Charlie Baker signed a law, referred to as Nicky’s Law after Nicky Chan, to create a confidential registry of caregivers who abused people with disabilities. State-licensed providers who care for people with disabilities will be required to check the registry and will not be allowed to hire anyone on the registry. The registry will include caregivers against whom an allegation of abuse has been substantiated through a civil investigatory process, and there will be a way for the caregiver to appeal. Someone can petition to have their name removed after five years. The registry will become effective January 31, 2021. Statistically, abuse of people with disabilities is rarely charged in court for a range of reasons. Victims may be nonverbal, their memories may be unreliable by the time an incident is reported, or they may face pressure from a place where they receive services not to testify. According to the bill’s sponsors, 26 states have registries to track individuals who abuse people with disabilities, based on agency investigations rather than criminal convictions. - See the full Commonwealth Magazine article.
Summer Camp Financial Assistance Options Many disability specific organizations like Asperger's Association of New England, local autism support centers, United Cerebral Palsy, and Easter Seals may be able to provide some funding for their summer programs. School Funding Another option is to learn if your child qualifies for an extended-school year (ESY). An Individual Education Program (IEP) that includes summer goals may qualify for summer programming. For additional information about special education extended school year program go to Massachusetts Department of Education. If you can prove that your child will be working on the skills outlined in his/her IEP at the summer program, the school district may pay for it. Talk to the school administrator early in the IEP process if you will be asking for school district to cover some of your child's summer program. Scholarships You can help fund your child's camp experience by applying for a scholarship. It is best to do so from December - March, because funds are usually depleted by April or May. Some camps have their own scholarship. Fraternal organizations may also provide assistance. Here are a few: Most of these organizations send the scholarship money to the camp in the child's name. - Adapted from a News-brief about from INDEX Brought to you by: DisabilityInfo.org, February 20, 2020
Tax Filing Reminders for Health Connector and MassHealth Members 2019 Tax forms have been recently mailed to Health Connector members and MassHealth members. These forms are needed when members file their state and federal taxes for tax year 2019.
For more information and links to other tax resources visit the Health Connector's Tax Filing page https://www.mahealthconnector.org/taxes Consumer Resources
- From Tax Filing Reminders for Health Connector and MassHealth Members, MA Health Care Training Forum, February 18, 2020.
State Suspending Farm Food Benefits Program – Healthy Incentives Program Demand Outstrips Funding A shopper using SNAP benefits can spend $1 to buy $2 of produce under the state’s Healthy Incentives Program, or HIP. But as of Feb. 24, shoppers on public benefits will no longer get that extra money. The state is suspending HIP for the winter, with plans to restore it May 15. State officials say the program – which doubles the impact of SNAP benefits when produce is bought from a participating farm – is a victim of its own success and has outgrown its budget. Without a temporary suspension of the program, state officials say its $6.5 million state appropriation would run out quickly and no money would be left during the busier buying and growing season this summer. Advocates for farmers and low-income individuals say the loss of HIP will hurt shoppers and sellers. Recently, 89 legislators wrote to Department of Transitional Assistance Commissioner Amy Kershaw protesting the suspension, and the lack of notice. Jess Vecchia, co-director of the nonprofit Roots Rising, said farmers already planted their crops in anticipation of a certain amount of sales. Shoppers have come to rely on indoor farmers markets to get fresh fruits and vegetables during the winter. HIP started in 2017 with a federal grant, and with projections that it would cost $1.25 million over three years. It took five months to reach that amount. State funding has steadily increased. It was $4 million in fiscal 2019, and the program was so successful that it had to be suspended during the winter to make the funds last through the end of the fiscal year. The state, realizing the $6.5 million budget won’t last until the end of June, is taking the same approach this winter. In the winter – when heating costs are high and fresh food is harder to get – advocates say the program remains vital. “People eat year-round and they want to eat healthy food year-round,” said Winton Pitcoff, director of the Massachusetts Food System Collaborative, a privately funded organization created to implement the state’s local food action plan. Pat Baker, senior policy analyst for the Massachusetts Law Reform Institute, said HIP is particularly important to make fresh produce available to seniors while addressing social isolation, since organizations take seniors to farmers markets. 89 legislators, led by Republican Shrewsbury Rep. Hannah Kane and members of the Food System Caucus, complain that DTA did not tell lawmakers about the suspension with enough time to let them appropriate money to avoid it. “We must register the devastating effects this suspension will have not only on our most vulnerable constituents who rely on the ability to purchase and consume fresh, nutritious locally grown food through this program, but also to the Commonwealth’s farmers who grew surplus crops with the understanding the program was year-round and will now have to sell the food for a fraction of the promised price, or outright donate the crops with no income or tax deduction available for doing so,” the lawmakers wrote DTA Commissioner Kershaw. - See the full Commonwealth Magazine article.
New Flyer- Programs that Disregard Census Income Working for the U.S. Census can pay well: around $25/hour in the Boston area (https://2020census.gov/en/jobs/pay-and-locations.html). However, that income is usually fairly short term, so folks who receive benefits may worry that the income, while quite temporary,will disqualify them from the benefits they already receive. As previously reported (US Census Income Non-Countable for SNAP, TAFDC and EAEDC, January 2020) DTA has announced that US Census income will not be counted in the eligibility calculations for SNAP, TAFDC and EAEDC. MRLI has now released a flyer that explains that these programs, as well as Fuel Assistance (LIHEAP), Federal and State Housing benefits, Emergency Assistance (EA- family shelter), will not count these earnings. Note: different rules apply to other programs not listed above. Census income MAY count for national school lunch and breakfast programs and WIC unless you are also receiving SNAP. Census income also MAY count for SSDI or Early Retirement benefits (contact SSA for more information. Census income WILL count for SSI – SSI will be counting about half of any earned income, including temporary Census earnings. Census income will NOT count for MassHealth for
BUT, for most other MassHealth members, Census earnings do count, but may not affect your MassHealth coverage. More on MassHealth: Census Income and MassHealth - See the full MLRI Infographic - Adapted from AARP MA eblast on US Census jobs; FAQ on Census earnings and benefits; Upcoming briefing for MA Legislators, Pat Baker, MLRI, FoodSNAP Coalition listserv, February 11, 2020.
Sealed criminal records still showing at FBI Tens of thousands of people have sealed criminal records under a 2-year-old state law that allows them to wipe clean some prior arrests and convictions, but the records are still turning up in federal background checks widely used by schools, banks, hospitals and casinos. The 2018 law, part of a criminal justice bill signed by Gov. Charlie Baker, shortened the waiting period from five years to three for people found guilty of misdemeanors to ask that a case be sealed. It shortened the waiting time for felons from 10 years to seven. The law also allows sealing of juvenile records and expands the list of offenses eligible to be scrubbed. Under the law, the state is required to notify the Federal Bureau of Investigation, which tracks state arrests and convictions, when records are sealed. But two years after the reforms went into effect, that still hasn't happened, according to state and federal officials and private attorneys who work on clemency issues. Felix Browne, a spokesman for the Executive Office of Public Safety and Security, said there isn't a process for the FBI to accept criminal records sealed by the state. Attorneys who work with clients trying to seal their records say the process is stalled and they can't get answers. "This has been going on for a very long time," said Phillip Arnel, a Westwood attorney. "I have a lot of clients who are extremely frustrated because they can't understand why their FBI records can't be sealed. When someone is arrested by state or local police, their fingerprints and information are sent to the FBI for review. The agency creates a federal record of the charges.The FBI generally doesn't update those records, however, so they show up even if someone is found not guilty, if the charges are dismissed or if the records are sealed. Sen. William Brownsberger, D-Belmont, a criminal defense attorney who helped write the 2018 law, said "we kept getting complaints from folks that sealing doesn't work." "No matter what happens to the state record, the FBI record lives on." A major issue is that the state and federal governments handle sealings differently, he said. The FBI seals a person's entire criminal record, while the state seals just individual charges. Massachusetts is known for being particularly unforgiving when it comes to allowing people to get out from under the shadow of a conviction. Criminal records can haunt people long past their punishment, criminal justice advocates say, preventing them from getting jobs or housing, or from getting into college. The overhaul approved by the Legislature and Baker in 2018 was meant to help people get on with their lives. It allows for an individual's criminal record to be wiped clean provided the offense occurred before their 21st birthday and they stayed out of trouble. Major convictions — such as for murder, felony assault, drunken driving, domestic battery, rape and other sexual offenses — cannot be sealed. The changes, which took effect in October 2018, prompted a surge in requests to seal records, with state officials processing an average of 7,000 per month. The new law also allows juvenile records and some adult crimes to be permanently removed from a person’s criminal record through a process known as expungement. Unlike sealing a criminal record, which can still be viewed by law enforcement, expungement permanently erases charges from someone's official record. The FBI also allows people to make direct requests to seal records, but criminal justice reform advocates say the process is costly and cumbersome. "It's a bureaucratic nightmare," said Margaret Love, executive director of the Washington D.C.-based Collateral Consequences Resource Center. "They don't make is easy for people." -See the full Newburyport News article.
New MA Hands-Free Driving Law Effective February 23, 2020 Massachusetts law now prohibits operators of motor vehicles and bicycles from using any electronic device, including mobile telephones, unless the device is used in hands-free mode. The “hands-free” law is effective as of February 23, 2020. Drivers who are 18 and over
Drivers who are under 18 Are not allowed to use any electronic devices. All phone use while driving is illegal, including use in hands-free mode. Operators may use a cell phone to call 911 to report an emergency. If possible, safely pull over and stop before calling 911. Penalty for violating the hands-free law:
- Source: Mass.gov
SJC Says Relatives Cannot Sue Nursing Homes for Wrongful Death They Sign Arbitration Agreements In a case closely watched by the AARP Foundation, the state’s highest court Thursday ruled that a relative of a nursing home resident who died due to possible neglect cannot file a wrongful death lawsuit if the resident signed an arbitration agreement with the nursing home. In the unanimous ruling ‚the Supreme Judicial Court agreed with the nursing home industry that Massachusetts’ wrongful death law, does not override arbitration agreements. If the resident waives their right to sue over negligence or death, that waiver is binding on loved ones, the court said. Justice David A. Lowy wrote for the court that arbitration overrides "wrongful death actions caused by willful, wanton, or reckless acts, as well as by negligence.” According to court papers, Jackalyn Schrader had power of attorney for her mother, Emma Schrader, when the older woman moved into the Golden Living Center, also known as Heathwood, in 2013. The daughter signed several papers including an arbitration agreement for the “Resident” that waived the rights of “next of kin...heir of the resident,” among others. Emma Schrader died in Dec. 3, 2013 after undergoing surgery for bed sores; she never recovered from the surgery, according to the court. Jacklyn filed a wrongful death suit, but the nursing home moved the case into federal court where the judges - and now, the SJC - said Jackalyn had no legal right to sue because of the arbitration agreement. In a friend of the court brief, the American Association of Retired Persons- the nation’s largest advocacy group for senior citizens - had urged the SJC to side with the daughter. "Maintaining the right of beneficiaries to publicly litigate disputes when a loved one has died at the hands of a nursing facility is critical to filling the void left by a lack of enforcement activity,'' the nation. "Forcing next of kin to arbitrate wrongful death suits removes a critical source of information about quality of care in nursing facilities.'' But the Professional Liability Association, an organization of Massachusetts hospital and health care providers, said courts in other states have enforced arbitration and the SJC should follow that model. "Agreements are enforceable provided that the agreement is executed by an authorized person and that it was not induced by fraud or undue influence and provided that it is not unconscionable,'' the association argued in its friend of the court brief. MGH Community News ed. note: advocates note that patients and families are presented with these agreements upon admission. They may not fully understand what they are signing, and even if they do, may not feel they can refuse to sign at that late stage of the process. One could argue this constitutes “undue influence.” -See the full Boston Globe article.
Insurers Sign $1M Settlement with Healey Over Mental Health Parity Five large Massachusetts health insurance companies and two behavioral health care companies have signed an agreement with Attorney General Maura Healey over allegations that they violated the state’s mental health parity laws. According to the settlement, released Thursday, a number of the state’s health care companies have been under-reimbursing mental health care services, required prior authorization for routine behavioral health office visits, and had inaccurate provider directories. The companies will also pay a combined $1 million for a fund to promote initiatives to broaden access to mental health. The settlements involve Harvard Pilgrim Health Care and its behavioral health management company United Behavioral Health, which does business as Optum; Fallon Health and its behavioral health management company Beacon Health Strategies; AllWays Health Partners; Blue Cross Blue Shield of Massachusetts and Tufts Health Plan. “Treatment for substance use disorder and access to therapy are vital to public health, but too many people are facing unlawful barriers to the care they need,” Healey said in a statement. “These companies are making substantial and unprecedented changes to help ensure patients don’t have to struggle to find behavioral health services in Massachusetts.” State legislators, attempting to broaden mental health care access, have often noted that Massachusetts already has laws that require parity between mental and physical health, but they are not often heeded. Gov. Charlie Baker and state senators have sought to increase access to mental health through two bills that remain under consideration on Beacon Hill. According to the settlements, Harvard Pilgrim, Fallon and AllWays had allegedly under-reimbursed outpatient behavioral health services than for comparable physical health services. A 2019 study looking at billing codes showed that primary care physicians in Massachusetts are paid 60 percent higher than behavioral health providers when providing comparable services using the same codes. Often, behavioral health providers cite the low reimbursement rates as a reason why they don’t accept insurance, reducing access for many patients. The three companies have agreed to change how they establish minimum reimbursement rates and subsequently raise those reimbursements, according to Healey's office. “Social workers are on the front lines in Massachusetts, treating and serving the state’s most vulnerable, yet reimbursement rates for this crucial workforce do not allow many social workers to earn a living wage,” Rebekah Gewirtz, executive director of the Massachusetts chapter of the National Association of Social Workers, said in a statement. “Those working in the mental health field ... have been undervalued and, frankly, taken advantage of for far too long," Gewirtz added. "The settlements announced today mark an important step forward for access to mental health services in Massachusetts.” The three companies have also changed the way they manage certain behavioral health services, including reducing what is known as “prior authorization” requirements. Such requirements ask that an insurer sign off on any service before it is delivered. Though that check helps reduce what can sometimes be seen as unnecessary care, Healey’s office said Fallon, through its administrator Beacon Health Strategies, had been requiring it for routine behavioral health office visits or inpatient mental health admissions after treatment in an ER. Harvard Pilgrim and AllWays, through its administrator Optum, had also allegedly overruled health care providers' decisions on “appropriate care,” including frequency of visits, or had used prior authorization requirements on substance use treatment out of network or outside of Massachusetts — in violation of state law. Both have agreed to change those practices. Additionally, Harvard Pilgrim, AllWays, Fallon, Optum, Beacon, Tufts and Blue Cross have agreed to improve the accuracy of their provider directories. About 57% of adults who sought behavioral health care struggled to obtain it in 2018, according to a Massachusetts Health Reform Survey. Those surveyed attributed the trouble securing services to inaccurate online directories, insurance companies denying coverage and providers declining to accept new patients.“Many of these directories claim providers are accepting new patients when they’re actually not. That’s a problem, and it’s really frustrating for patients and families in desperate need,” Healey said during a news conference Thursday. Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said the problems alleged in the settlement grew out of uneven applications of federal mental health parity laws, passed in 2008. "To ensure a clear and consistent application of the federal law in Massachusetts, it is imperative that the Attorney General and state agencies work together to establish a uniform interpretation of the federal mental health parity law and issue state guidance so that Massachusetts consumers, employers, providers and health plans can understand their rights and responsibilities under the law free of competing interpretations," Pellegrini said in a statement. Pellegrini added that health plans have invested for the past two years in technology for better provider directories, and the state passed a law in 2019 requiring health plans to ensure accuracy in provider directories by October 2020. - See the full Boston Business Journal article. Additional material from Mass Live.
Trump Expands Travel Ban Early this month, the Trump administration announced an expansion of the travel ban policy (unrelated to coronavirus fears), barring almost all nationals of Nigeria, Eritrea, Kyrgyzstan and Myanmar from entering the U.S. (except people eligible for Special Immigrant Visas for having aided the U.S. government). In addition, citizens of Sudan and Tanzania are now excluded from the Diversity Lottery Program. The travel ban will also continue to cover the original seven countries: Iran, Libya, Syria, Yemen, Somalia, Chad, North Korea and Venezuela (a limited segment of travelers). Since 2017, the ban has excluded many thousands of travelers, especially from the five Muslim-majority countries, separating married couples and families, keeping valued workers away from U.S. employers, and causing significant suffering. MIRA Coalition advocates said in a statement “People of conscience all across the U.S., including immigrant and civil rights leaders and many public officials, have denounced this cruel and senseless policy. We stand with them. America is better than this.” - From MIRA Coalition, February 04, 2020
Somerville Helps Tenants Fight Eviction with Information As many area families struggle with the high cost of housing, Somerville has taken a new step to stem the tide of evictions. Under a city ordinance that took effect Dec. 26, when landlords serve an eviction notice they must include information sheets prepared by the city that inform the tenants of their legal rights and available resources to help them avoid displacement. The information includes the right to file an answer to an eviction complaint filed in court. The resource document lists organizations that assist with paying back rent, moving expenses, pre-court advocacy, and legal counsel. “State statistics show that under 8 percent of tenants are represented in eviction cases, compared with 70 percent of landlords,” said Ellen Shachter, director of the city’s Office of Housing Stability. “This is really just a way of reaching tenants at a critical juncture so they can explore their options.” Shachter said in her previous work as an attorney representing tenants in eviction cases, she saw countless instances in which “parents and children ended up homeless when with earlier intervention that wouldn’t have happened.” The requirements of the Housing Stability Notification Act, which the City Council unanimously adopted in September, also apply to banks or others who have purchased foreclosed properties and seek to evict the former owner. Somerville is the only municipality in Massachusetts to require the tenant notification, according to Shachter. “This new act seeks to ensure any resident facing eviction has access to every tool and support available to them,” Mayor Joseph A. Curtatone said in a statement. The city’s Inspectional Services office will enforce the ordinance based on tenant complaints. Landlords who violate the ordinance will receive a warning for their first violation and can then be fined $300 for each subsequent violation. “Our goal is not to fine people but to make sure landlords understand their obligations,” Schacter said. In fiscal 2019 alone, about 289 eviction actions were filed in court against Somerville tenants, which Shachter noted does not take into account potential evictions avoided by tenant relocation or intervention from the city or agencies. Soaring rents and an undersupply of affordable housing are the key factors behind the evictions, according to Shachter. Citing Metropolitan Area Planning Council data, she said the average monthly rent for a two-bedroom apartment in Somerville last fall was $2,612. The number of evictions filed in court actually fell from an estimated 400 in fiscal 2017. But Shachter said housing instability remains acute in Somerville, noting that since her office was established a year ago, it has received nearly 500 requests for assistance, most from families in urgent need of affordable housing or facing eviction. - See the full Boston Globe article.
A Place for Mom – Free Assistance with Long-Term Care Placement A Place for Mom is a national organization that connects families with local Senior Living Advisors. They help families find senior living communities that meet their needs and offer advice and support. Services might include education about types of care and help matching to the patient’s needs, helping to schedule appointments and tours and offering emotional support through the process. They are able to offer services free to families as they are paid by their partner communities if you decide their referral is a good fit and you decide to move-in. If engaging this service, please keep in mind that it is in their interest to recommend participating providers, and that their listings may not include all local facilities.
Bridge for Resilient Youth in Transition Helps High School Students Return to School After Extended Mental Health Absences As many as one in five children need help with a mental health condition such as anxiety or depression. These students often have trouble processing information or focusing, which can contribute to a cycle of increased anxiety, dropping grades and missed school days, say experts. Yet schools typically lack the money and staff to help students cope with what experts describe as a mental health epidemic. One study found that nearly 80 percent of students failed to receive the mental health care they needed, and more than 50 percent of students ages 14 and older with emotional and behavioral disabilities drop out of school. “Districts that are less resourced might be sharing one psychologist for the entire school district, or one psychologist who is responsible for 3,000 kids,” said Kelly Vaillancourt Strobach, policy director for the National Association of School Psychologists (NASP). “When you have these shortages of these professionals, you’re really only able to serve those kids who are in extreme crisis.” Absent a national blueprint for helping students cope with mental health conditions, states are scrambling to identify potential prototypes. The Bridge for Resilient Youth in Transition (BRYT) program, which was founded and pioneered in a Boston-area school in 2004 by the nonprofit Brookline Center for Community Mental Health, has emerged as a successful model for helping kids re-enter school after a mental health crisis. The Brookline Center works with school districts to help them plan and implement BRYT programs, which are staffed by school employees. Although the center doesn’t finance programs, it helps schools identify potential sources of funding. Ninety percent of students in BRYT remain on track to graduate, and their attendance rates have increased from 52 percent before participation to above 80 percent after. The program itself is expanding. BRYT’s director, Paul Hyry-Dermith, said 137 schools in Massachusetts now employ the program and pilots are starting to roll out in Rhode Island, New York and New Hampshire. Partnerships are also in the works with school districts in Washington state and Oregon. At Cambridge Rindge & Latin, an ethnically diverse school that in 2018 sent 82 percent of its graduates to college, the BRYT classroom is tucked at the end of a quiet hallway. Eleven students spend one assigned period a day here, where they chat with counselors, prepare for and work on homework assignments with the program’s academic liaison, or simply rest and relax. Students are also welcome in the room any time they feel overwhelmed. “Many of the kids in our program are coming out of a psychiatric hospitalization,” said Ashley Sitkin, BRYT clinician/program leader at Rindge & Latin. “Some of the kids haven’t been hospitalized but they’ve missed a lot of school because they’ve gotten stuck in this avoidance cycle, which is really common for kids who struggle with anxiety and depression.” At Rindge & Latin, Sitkin and her colleague, academic coordinator Nkrumah Jones, disrupt that cycle with a three-to-four-month reintegration plan that includes emotional support and mental care coordination. That includes a clinical diagnosis of students before they enter the program, and constant contact with outside health providers who also provide each student with care. Sitkin and her staff also reach out to parents and keep them informed. Academic coordination is crucial, too. Both BRYT coordinators and teachers acknowledge it is unrealistic to expect students who miss weeks of school to make up all class work, so care coordinators serve as a liaison between student and teacher, indentifying key assignments and ironing out a make-up plan. - See the full PBS story.
Stupid Cancer Each year, 77,000 young adults (ages 15-39) are diagnosed with cancer in the United States alone. That’s one every eight minutes. This neglected group faces age-specific challenges - such as, infertility, loss of identity and independence, lack or loss of insurance, increased isolation, and stalled career development - with limited resources. Stupid Cancer offers a lifeline to the young adult cancer community by connecting them to age-appropriate resources and peers who get it. Programs include meetups, webinars, a blog, an annual 4 day conference “CancerCon” and more. Learn more: https://stupidcancer.org/
Irish International Immigrant Center Becomes the Rian Immigrant Center The Irish International Immigrant Center announced this week that it has changed its name to Rian Immigrant Center. Rian (Ree-Ann), the Irish word for path, honors our Irish roots while reflecting our inclusive mission of empowering immigrant and refugee families on the path to opportunity, safety and a better future for all. Founded by a small group of Irish immigrants, Rian has continued to help all newcomers along the path to safety and opportunity for more than 30 years. “Our work has never been in higher demand,” said Ronnie Millar, executive director of the Rian Immigrant Center. “In recent years that path has grown more difficult. Legal obstacles, bureaucratic thickets, even physical barriers obstruct the path to legal status and citizenship. Together with our public and private partners, we are undaunted in navigating those challenges, and we remain steadfast in creating pathways to new beginnings.” About Rian As Boston’s welcome center, the Rian Immigrant Center creates pathways to new beginnings for immigrants and refugees from more than 126 countries by providing the legal, wellness and educational support they need to build successful lives. Building on its Irish roots of welcoming others and advocating for social justice, Rian helps newcomers find community and stands up for immigration policies that are humane and just. Rian understands that our existing communities benefit when immigrants are safe, welcomed, and able to fully participate in society. The new Arbella Foundation Immigrant Learning Center at Rian’s downtown Welcome Center is also a testament to Rian’s commitment to providing more integrated support to immigrant families. Additionally, Rian is continuing to expand its partnerships with local schools, hospitals, community-based organizations and recently launched a new civic engagement program for those on the path to citizenship. See www.riancenter.orgfor more information on the ongoing work to support immigrant families in Massachusetts. -See the press release.
State to End Premium Assistance for Poor College Students Citing “untenable” price increases, state officials are scrapping a program that was intended to save the state’s Medicaid program tens of millions of dollars and offer better health care options to thousands of poor college students. The Baker administration’s decision to eliminate its so-called premium assistance program for student health insurance plans, called the Student Health Insurance Program, means 21,000 students will shift off Blue Cross Blue Shield of Massachusetts plans offered through their schools. MassHealth, the state’s taxpayer-funded Medicaid provider, then becomes their primary insurer. That, some warn, could limit access to services a vulnerable population of students has enjoyed under the private plans, which offer a broader network of doctors and coverage. The move marks a quick demise for a program the Baker administration had called a cost-saver just three years earlier. First launched ahead of the 2016-2017 academic year, the program later required MassHealth-eligible college students to enroll in health plans offered by their college, with MassHealth paying toward their premiums. At the time, state officials described it as a win-win: They estimated in 2017 that it would save $45 million, and the students, without shouldering any additional out-of-pocket costs, would have access to a wider network of providers beyond MassHealth and even health care coverage outside the country. (MassHealth covers only emergency care outside the state.) But costs quickly started to rise for the state, which had to cover ever-increasing premiums that Blue Cross Blue Shield said were fueled by its coverage of the MassHealth students. Premiums for the plans jumped 20 percent this academic year, and state officials said they were projected to jump by nearly 50 percent next year if MassHealth members remained in the program. Despite initially projecting tens of millions of dollars in savings, state officials say scrapping the program won’t add substantive costs. The 21,000 students are already counted on MassHealth rolls — the state was serving as their “secondary” insurer — and the rising premiums ate into the savings to such a degree that the program was becoming “too expensive,” officials said. MassHealth students had medical expenses that were close to or more than double that of others, with claims for behavioral health and substance use services helping drive the costs. All full-time college students are required under state law to have health care coverage, and must enroll in a school-sponsored health care plan if they aren’t already covered by their parents’ or some other plan. MassHealth officials disputed that, arguing it provides “comprehensive medical and behavioral health benefits.” Devine said his group is also working with the state to help communicate with students about their options. But, Devine said, eliminating the program, and pulling MassHealth students from the school plans, should help lower premium costs for non-MassHealth students who will remain. - See the full Boston Globe article.
Medicare Reminder: Special Needs Plans Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, SNPs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some SNPs offer additional benefits, such as vision and hearing care.
You must have both Parts A and B to join a SNP, and generally you will continue paying your Medicare Part B premium, though some SNPs will pay part of this premium. Some SNPs will charge an additional premium, on top of your Part B premium. You may be eligible for other forms of premium assistance if you are eligible for a SNP. SNPs are also required to provide Part D coverage. - From Medicare Watch, Medicare Rights Center, February 13, 2020
Medicare Reminder: Medicare and Travel Medicare’s coverage of care when you travel depends on where you travel and how you receive your Medicare benefits. Travel within the U.S. If you have Original Medicare, you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most doctors and hospitals take Original Medicare. If you have a Medicare Advantage Plan, your plan may or may not cover care outside of its service area. Some plans may cover providers that are out-of-network or out of your service area, but with higher cost-sharing (copayments, coinsurances). Your plan may also impose other rules or restrictions (like prior authorization). Contact your plan to see what rules and costs apply when you travel within the U.S. Note: Medicare Advantage Plans are required to cover emergency and urgent care anywhere in the U.S. without imposing additional costs or coverage rules. If you travel outside your Medicare Advantage Plan’s service area continuously for more than six months, you will automatically be disenrolled from most plans. You will have a Special EnrollmentPeriod to join a different Medicare Advantage Plan. If you do not choose a new plan, you will automatically be enrolled in Original Medicare. Some Medicare Advantage Plans provide special benefits that allow you to stay in the plan if you travel continuously in the U.S. or its territories for up to 12 months. Check the rules closely if your plan offers a visitor or travel benefit. Only certain areas may be included, certain care may not be covered, and/or you may pay more if you see providers that are outside the plan’s network. Travel outside the U.S. Medicare usually does not cover medical care you receive when traveling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:
Some Medigap policies provide coverage for travel abroad. Medigap plans C through G, M, and N cover 80% of the cost of emergency care abroad. Check with your policy for specific coverage rules. Medicare Advantage Plans may also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules. Visit Medicare Interactive to learn more about Medicare coverage. - From Medicare Watch, Medicare Rights Center, January 30, 2020.
President Trump’s Budget Proposal Renews Calls to Cut Medicaid, Medicare, Social Security, SSI and Totally Eliminate Legal Services Funding The President’s budget is a statement of values. The President’s budget calls for $1 Trillion in cuts to Medicaid achieved by cutting federal funding and encouraging states to use red tape to create eligibility hurdles and kick people off of coverage. Many of these proposals are directly aimed at older adults who lose their jobs, can no longer work, or retire before becoming eligible for Medicare, as well as family caregivers. The greatest harm would be borne by women and people of color. To be sure, though, capping and cutting Medicaid would weaken the program for all older adults, people with disabilities, and each of the 70 million Americans it serves. The budget makes significant cuts to Social Security, Supplemental Security Income, Medicare, and other critical programs, making it harder for older adults to see their doctors, pay rent, put food on the table, and meet their basic needs. The budget also calls for entirely eliminating legal services funding, reducing access to justice for older adults and their families. The President’s budget would worsen inequities, increase disparities, and make life more difficult for seniors and families living in poverty. - From Federal Budget Proposal Renews Calls for Cuts to Senior Programs, Justice in Aging, February 11, 2020.
Advocacy Opportunity- Ask the FTC to Require Funeral Homes to Post Prices Online The Federal Trade Commission (FTC) has opened a comment period on the FTC Funeral Rule. The Rule gives people rights to important information, and lets them compare prices among funeral homes. Under the Rule, funeral providers must give you an itemized price list when you visit a funeral home to ask about funeral services, and let you see a casket price list before you see the caskets. And, you don’t need to visit a funeral provider to get information; the Rule says funeral homes must give you price information over the phone if you ask for it.
Bill Would Make It Easier For Homeless To Get Massachusetts State ID Card A new bill, sponsored by Sen. Harriette Chandler, would require the registrar of motor vehicles to come up with what supporters call a burden-free process for homeless individuals to obtain the IDs. That process would be free of fees and would accept alternative forms of documentation to prove Massachusetts residency, including information from homeless service providers or other state agencies. The specific kind of documentation would be left up to the registrar. The Worcester Democrat said IDs are essential for everything from opening a bank account and applying for a job to getting into stable housing and interacting with police. Chandler said under current law, gathering the necessary documents and coming up with a fee can be insurmountable barriers for some people, particularly unaccompanied homeless youth and LGBTQ youth who are homeless. Chandler pointed to a study commissioned by the Office of Health and Human Services that identified 3,789 unaccompanied homeless youth across the state in 2018. The study suggested that number was likely an undercount. - See the full CBS Local story.
Legalizing Debt Service Companies in Mass. Raises Concerns Since 1971, Massachusetts has outlawed for-profit debt counselors because of unscrupulous practices by some that exacted high fees and left consumers deeper in debt. But a loophole in the statute has allowed affiliates of these for-profit companies to operate in the state in recent years, largely unregulated. The proposed legislation, passed by the House last year and supported the administration of Governor Deval Patrick, would end the 43-year-old ban, but subject the firms to increased oversight by the state. The bill is now before the Senate Ways and Means Committee. Barbara Anthony, undersecretary of the Massachusetts Office of Consumer Affairs and Business, said the legislation would allow the state to set rules and crack down on violators. “This bill would require all previously unlicensed debt management, debt settlement companies, and for-profit debt counselors to become licensed to dispense advice to consumers and to be held accountable for any unfair or deceptive actions,” she said in a statement. But consumer advocates say the proposal would undo four decades of consumer law in the state and extend the reach of for-profit debt counseling firms, which are legal in some states, into Massachusetts. House sponsor, Representative Michael Costello, said there is a high likelihood that the bill will pass before the Legislature adjourns at the end of this month. Debt relief counseling services aim to help financially strapped consumers reduce and manage their bills, acting as an intermediary between debtors and creditors. They typically work out a repayment plan that might include the waiving of penalty fees, the reduction of interest ,or both, and collect monthly payments from consumers, which they pass onto the creditors. On average, nonprofit servicers charge a fee of $26 per month; for-profit firms can charge as much as 18 percent of outstanding debt, according to federal reports. For-profit firms have come under scrutiny for collecting these fees, but too-often doing little to help debt-ridden consumers. A decade ago, the Federal Trade Commission found that for- profit firms, some masquerading as nonprofits, imposed undisclosed fees, made unrealistic promises about reducing debt and interest, and failed to pay creditors with money collected from their clients. In 2010, with complaints about for-profit debt relief companies on the rise again, the FTC prohibited for-profit debt companies from taking money from consumers before providing significant help. Massachusetts ban on for-profit debt counseling companies kept them out of the state for decades. But in recent years, the firms have exploited a loophole in the law through affiliates that call themselves “debt-settlement” rather than “debt counseling” firms. Instead of collecting payments directly from consumers and passing it onto creditors, debt settlers advise consumers to stop all payments and put that money in a bank account. The companies claim they then will persuade creditors to accept smaller, lump-sum settlements that will come out of bank account, from which the debt firms also take fees of as much as 18 percent. Consumers often end up worse than before, critics says, owing more money, having less, and facing lawsuits from creditors. But consumer advocates argue for a simpler approach: banning debt settlement firms from the state as well. “In virtually every circumstance there is no benefit whatsoever to consumers,” said Stuart Rossman, director of litigation for the National Consumer Law Center, a Boston base-advocacy group. - See the full WGBH story
Worcester Using Canadian Model to Connect People to Needed Services For the past two years, Worcester city officials have employed a model out of Saskatchewan, Canada, designed to reduce crime and connect the most at-risk residents to services by having social service groups and medical providers join weekly meetings. The group is called the HUB. Meetings occur Tuesdays at the Regional Emergency Command Center. Led by project manager John Genkos of the city manager’s office, the meetings bring police, fire, and the city’s Quality of Life Task Force to the table with dozens of organizations and agencies. The HUB systematically discusses and sets a course of action to help troubled people they encounter on the streets. Previously, this work was done in “silos,” and so the multifaceted approach brings about better and faster results, members of the group say. As an example of success, Firefighter Kate Harrington said, investigators learned two years ago that a city youth was setting fires. Harrington set out to speak with the family. “The kids were a little bit more than the parents could handle,” Harrington said, noting that three of the four children have autism. “So, I put up smoke and carbon monoxide alarms in their house, and said, ’Would you be willing to get some more help?” The mother agreed, and a plan-of-action that included You Inc. and the UMass Memorial Trauma Center connected the family to services and home therapy treatments. “The kids are great and we really haven’t had any reported fires from the juvenile,” said Harrington, who added that the HUB has also targeted hoarding situations, which present a hazard to both the resident and firefighters if they need to rescue someone from a cluttered home. Police Officer Angel Rivera said the HUB is valuable to police in that it wants to divert people with substance use disorders or mental illness from the criminal justice system when they commit lesser offenses such as trespassing, violating open container laws, and minor shoplifting. This allows police to focus on more serious crimes, he said. The HUB model originated around 2011 in Prince Albert, a city in Saskatchewan. Its founder, a former Prince Albert police officer, travels throughout Canada and the U.S. to promote the HUB. Genkos, the city project manager, noted that service providers are prohibited from freely sharing private citizens’ details, and so their case has to pass filters that are discussed during meetings. If the person has an acute elevated risk level, and involves several service sectors, the HUB may discuss the person by name and details of their situation. The case is then matched with the appropriate agencies. Genkos said police, the quality-of-life team and the state Department of Children & Families bring the most situations to the table, and the top five risk factors last year were basic needs, mental health, physical health, housing, unemployment, poverty and drugs. The threshold for HUB involvement is six or more risk factors, he said. Amy Ebbeson, clinical director of Worcester Addresses Childhood Trauma, an agency partner, said she also appreciates being able to meet with various disciplines. “I’m often at tables where it’s just social service providers - Open Sky, the Bridge,” she said. “It’s a great way to collaborate across systems that don’t talk to each other because they don’t have the forum,” she said. - See the full Worcester Telegram article.
Fraught Decision: Older Drivers Agonize Over When to Give Up Keys At a time when older Americans make up nearly a fifth of the nation’s drivers, it isn’t just family raising concerns. A loose network of auto insurers and medical professionals is also trumpeting safety behind the wheel to the more than 40 million seniors with active licenses. And yet, the decision to stop driving remains intensely personal. Many say they dread “the conversation” with grown-up children. Those children find talks about driving fraught, and they often avoid them. “Adult children need and want to see their parents as strong and competent,” said Lissa Kapust, director of the DriveWise safety assessment program at Boston’s Beth Israel Deaconess Medical Center, which tests older drivers and deems them safe or unsafe. “A son will remember in a crystal clear way how his father taught him to drive. How’s he going to tell his father that he’s no longer capable of driving?” Kapust said everything about giving up driving is emotionally charged. “More than any other issue," she said, "this will bring families to their knees.” Though they are, more or less by definition, the most experienced drivers on the road, some seniors struggle with concentration, worsening night vision, or medication-induced drowsiness. And advanced lighting technology — brighter headlights on cars and powerful light-emitting diodes installed in traffic signals — can be hard for older eyes to tolerate. Seniors often delay hanging up the keys for as long as they can. But a collision or health reversal can force their hand, sending them to a driver assessment program to undergo a battery of cognitive and on-road tests. For the many seniors who choose to stop driving but keep their car keys at the ready, relief and denial can coexist for months, or even years. For those who do stop driving, the lack of mobility may be contributing to a loneliness epidemic seen among older Americans. Driving is often what links people to their exercise class, their place of worship, their favorite coffee shop. These days, technology offers car-less seniors more options, freeing those who can pay for rides from depending on neighbors. Unlike past generations, seniors relinquishing licenses are a mouse click away from delivery or ride-sharing services. But in remote settings, ride-sharing services can be harder to access, and family and friends often pick up the slack. - See the full Boston Globe article.
A Novel Approach to Counseling Depressed, Anxious Teens: Video-Chatting with Therapists Virtual counseling visits are part of an experimental effort to address a pressing public health challenge confronting Massachusetts: how to deliver quality mental health care to all the teenagers who need it. The shortage of providers in rural areas is so severe that kids typically have to wait months to get an appointment, especially if their families are on Medicaid. Even when a therapist can be found, transportation is often an obstacle. Three schools in rural school districts in Western Massachusetts are participating in a pioneering telehealth project. Students who need mental health counseling can see a therapist via video chat on secure, school-based computers. Because the therapists can live anywhere, and neither they nor the students have to travel, therapy can usually begin just a few days after a student is identified as needing help. Parents don’t have to miss work to drive their kids to an appointment, and the amount of school students miss is kept to a minimum. “That’s dropped the no-show rate [compared to doctors’ office visits] to near zero,” said Maureen Donovan, the program’s manager. Exactly how effective long-distance psychotherapy is, compared with in-person office visits, remains unclear. Still, Boston Children’s Hospital has seen encouraging early results. Its Pediatric Physicians’ Organization is expanding teletherapy options after a successful two-year pilot program that delivered telepsychiatry evaluations to some 600 youngsters in the Southeastern and Western parts of the state, and in Lowell. Families made the computer-based visits at their local doctors’ offices. “Across the state, kids are waiting six to eight months or more to see a child psychiatrist, but we were able to pretty reliably connect them with a psychiatrist at Children’s in approximately 15 days,” said program manager Jonas Bromberg. A survey of patients and their physicians found a 90 percent or higher satisfaction rate when they were asked about waiting times and quality of care, he said. Bromberg also said they found virtual visits typically work best for children over 12 years old. Now the Western Massachusetts experiment aims to provide researchers with more insight. Heywood Healthcare which received a $1 million federal grant to run the three-year, school-based project, is collecting reams of data about how students are progressing. At one school in Orange, teletherapy is free to any student who needs it, regardless of insurance, with federal grant money plugging any gaps in coverage. (Leaders of the effort say the service wouldn’t need extra support if state lawmakers adopt pending legislation that would require insurers to spend more on mental health and to reimburse counselors at the same rate for telehealth services as they do for in-office visits.) The video sessions aren’t designed to treat students who are suicidal or psychotic or who need intensive help. Instead, they’re meant for those experiencing mild or moderate symptoms of the most common mental illnesses, such as depression and anxiety, or who are struggling with the stress that often comes with modern teen life. Each participating school also has a full-time community health worker to coordinate with guidance counselors in identifying students who need help. State Senator Julian Cyr, whose Cape Cod and Islands district grapples with severe health care shortages, included a provision in a mental health care bill filed this month for the state to try similar programs in three other public high schools. “This is a model that’s working, and we should see if we can apply this more broadly,” said Cyr, who cochairs the Joint Committee on Mental Health, Substance Use, and Recovery. Meanwhile, at the Orange school teletherapy has become so popular it has a small waiting list. Staffers who worked so hard to ensure students didn’t feel stigmatized for attending sessions are having to gently convince some that they are well enough to scale back to biweekly sessions, freeing up space for others. - See the full Boston Globe article.
|