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MGH Community News |
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MGH Community News |
| December 2012 | Volume 16 • Issue 12 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
The RIDE In Person Assessment Begins and New Immediate Service for Medical Necessity The MBTA’s The RIDE program has begun using In Person Assessment for new applications. (Note: residents of Natick and Framingham are served by a different agency- MetroWest Regional Transit Authority. They still use a paper application and none of the following applies to them.) The new RIDE Eligibility Center opened its doors on December 10, 2012. All new applicants should call the Eligibility Center 617-337-2727 to make an appointment for an in person assessment. Some of the details have changed in the year since it was first announced. We’ve been informed that some of the details may still change. Here’s what we know now:
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Emergency Assistance (EA) Family Shelter- Rules Finalized As reported previously (Emergency Assistance (Family Shelter) New Eligibility Categories, MGH Community News, September 2012, and EA Further Updates, MGH Community News, October 2012) The state’s Department of Housing and Community Development (DHCD) has issued final rules for eligibility for Emergency Assistance (EA- family shelter). The new rules which became effective on 12/7/12 include some tweaks in response to advocacy efforts, but the key provisions limiting access to family shelter remain in place without significant changes. New provisions/clarifications: Reference Documents and for more information: Southwest Airlines Grant Program- Renewed for 2013 We are thrilled that the Social Service Department has been accepted into the Southwest Airlines medical grant program again for 2013. The Community Resource Center administers this program. 2012 passes can only be used during calendar year 2012. We are expecting the 2013 passes in the very near future, so feel free to contact Community Resource Center Staff to check on their availability. More information available on our website at Southwest Airlines Passes. NEW EBT Card Replacement Fees and Exemptions Due to allegations that some members are selling their EBT cards, DTA has issued new rules on replacing or changing a cash assistance EBT card (DTA Operations Memo 2012-56, December 6, 2012). To get a replacement card, call or go to your local DTA office. DTA will deduct a $5 replacement fee from your next TAFDC or EAEDC semi-monthly grant. You will not get notice of your right to appeal the $5 fee and you will not get notice of the reasons a fee should not be charged. You should NOT be charged a replacement fee if: DTA should issue your replacement card the day you request it or the following day. If DTA plans to charge the $5 replacement fee, they will give or send you a form notice that says you will be charged. You can request a refund if you disagree for one of the reasons above. If you request more than four replacement cards (including a SNAP-only card) in a 12-month period, you will have to speak with a DTA worker to get another card. If your worker is not available, you should speak with the worker on duty. Important reminders: For more information contact Mass. Law Reform Institute, Deborah Harris, dharris@mlri.org, 617-357-0700 x 313 or Pat Baker, pbaker@mlri.org , 617-357-0700 x 328. Social Security Cost of Living Allowance (COLA) for 2013 The nation's elderly and disabled Social Security recipients will receive a 1.7 percent increase in payments in 2013. This is expected to raise the average monthly payment for the typical retired worker by $21. The increase is less than half of last year's 3.6 percent cost-of-living adjustment (COLA). Unfortunately, the modest rise will probably be at least partially offset by Medicare's premium increases for 2013, which will be announced soon. The same COLA will apply to pensions for federal government retirees and most veterans. For 2013, the monthly federal Supplemental Security Income (SSI) payment standard will be $710 for an individual and $1,066 for a couple. For a complete list of the 2013 Social Security changes, go to: http://www.socialsecurity.gov/pressoffice/factsheets/colafacts2013.htm - Adapted from News from Margolis & Bloom, LLP - December 10 2012 and http://attorney.elderlawanswers.com/newsletter/actions/view-article/c/862/cs/7f988cc971f42d3fb171600abe89e55e/id/574
Boston residents will soon be able to conduct their municipal affairs without trekking to Government Center, due to a mobile outreach program that will bring City Hall to the neighborhoods. Residents can get a certificate of residency, get birth, death or marriage certificates, even register to vote, and more at a van dubbed “City Hall To Go.” A newly refurbished bomb squad van, the vehicle is essentially a rolling office, outfitted with laptop computers, wireless access, and the necessary paperwork from a host of city departments. The van will be available periodically this winter to drum up awareness, before appearing in earnest next spring. City officials will survey residents to determine the best times and locations and may offer evening and weekend hours as a convenience. Since most of the available tasks can be handled online, the van will try to reach residents who are less Internet-savvy or who speak limited English and may need help navigating a process. City officials say the program is the first of its kind nationally, and they hope it proves a convenient alternative for residents who do not use the Internet or rarely get downtown.
The interior of the City Hall To Go truck has laptop computers and wireless Internet access. -See the full The Boston Globe article … Vehicle Registration and Immigrants in Massachusetts- Update As you likely recall, the summer of 2012 saw the adoption of an outside section of the state budget, over the Governor's amendment and subsequent veto, imposing new documentation requirements to register a vehicle in Massachusetts. Immigrant rights advocates opposed this outside section because its ambiguous language could potentially have led to discrimination against immigrants. However, the statute required implementing regulations before it could take effect in January 2013. The Department of Transportation has now proposed regulations, and MIRA has submitted comments in support of those regulations. MIRA considers the proposed regulations to be a sensible and non-discriminatory means of implementing the new law. Beginning January 1, 2013, the proposed regulations would require any applicant to register a motor vehicle in Massachusetts to provide one of the following documents or pieces of information: The proposed regulations provide special exemptions from these requirements (in the form of alternative requirements) for non-residents who are students or military personnel, and for residents who are senior citizens or disabled. See the proposed regulations. DOT will continue to accept comments on the proposed regulations until 5:00 p.m. on December 28. If you have any questions about the impact of the proposed regulations, or about the process for submitting comments, please contact Shannon Erwin, State Policy Director, at serwin@miracoalition.org or (617)350-5480 x222. -From For Directors: Latest on Vehicle Registration Regulations, MIRA Coalition, December 21, 2012. Mass Fails to Curb SNF Use of Antipsychotics State regulators rarely take action against Massachusetts nursing homes that, contrary to federal guidelines, use powerful anti-psychotic sedatives to control unruly elderly residents, a Boston Globe investigation has found. Just 27 homes were cited for unnecessary use of antipsychotics from 2009-11, and inspectors in each of those cases did not deem the incidents as serious. The homes were not fined. Federal guidelines say that antipsychotics are intended for patients with severe mental illness and a handful of other conditions, but many nursing homes administer them more broadly to residents who punch, kick, or shove others. Often that includes residents with dementia, despite federal warnings about potentially fatal side effects in such patients. Government data show that antipsychotics are overused more often in Massachusetts nursing homes than nationally. In the cases where homes were cited, inspection reports described residents who had been on antipsychotics for months, and sometimes years, without evidence that staff tried to wean them off — as required by federal law. Dr. Madeleine Biondolillo, Massachusetts’ top nursing home regulator, said her inspectors “try hard to have a justification” to reprimand facilities for antipsychotic use they feel is unnecessary. But she said federal rules are ambiguous, and harm from inappropriate use of antipsychotics can be subtle, indirect, and come weeks after a patient is put on them — making it difficult to penalize a facility and make it stick when the homes appeal the citation to an independent review board. Federal regulators are finalizing new guidelines that will more clearly define the approaches nursing homes must first try with agitated or combative residents, ruling out other reasons for their behavior — such as infections, hunger, thirst, or pain — before using antipsychotics. Biondolillo’s agency is crafting new dementia care regulations, to go into effect by April 1, that will require enhanced training for Massachusetts nursing home staff on alternative techniques to calm agitated residents without resorting to antipsychotics. -See the full The Boston Globe article …
Partners HealthCare Helps Boston Students Learn to Manage Emotions and Resolve Conflicts At the end of November, Mayor Thomas M. Menino announced that Partners HealthCare, and its founding hospitals Brigham and Women’s and Massachusetts General Hospital, is committing $1 million to the Boston Public Health Commission for a collaborative effort among the two organizations and the Boston Public Schools to implement a social and emotional learning curriculum for 7,000 students in 23 Boston public elementary and K-8 schools. Coordinated by the Boston Public Health Commission’s Division of Violence Prevention, the collaborative will strengthen students’ skills so that they are empowered to promote positive behaviors and healthy relationships at school and in their community. By focusing on social and emotional learning, the organizations hope that educators can proactively address conflicts before they come to a head, instead of addressing the negative outcomes after the fact. “Our goal is to help young people better understand their emotions and be able to talk about them and learn to manage them. This project will help young people develop skills for healthy, positive relationships,” said Gary Gottlieb, MD, President and CEO of Partners HealthCare. “By working with the Mayor and Boston Public Schools on this initiative, we want to support our young people in the classroom and in the community.” The two-year grant will provide training and professional development for 750 teachers, teaching assistants and principals to implement the evidence-based Open Circle Curriculum. At the heart of the curriculum are 15 to 20 minute classroom meetings led by homeroom teachers twice per week. These interactive meetings include group discussions, role-playing, children’s literature, and activities to teach important skills such as listening, sharing, cooperating, speaking up, calming down, expressing anger appropriately, recognizing dangerous and destructive behavior, and problem solving. These lessons are further reinforced throughout the school day as all staff members integrate the promotion, modeling, and labeling of positive social and emotional skills into their teaching practice, their relationships with students and their relationships with colleagues and parents. Recent research has shown that social and emotional learning does more than improve behavior. It can also help students make significant gains in academic achievement — on average, a gain of 11 percentile points in reading and math, according to a 2011 review of more than 200 studies published in the journal Child Development. Social and emotional learning also equips students with the skills that today’s employers consider important for the workforce of the future – communication, collaboration, cooperation, goal setting, problem solving, and persistence in the face of challenges. -See the full press release…
Medicare Improvement Standard Ending- New Details As reported previously (Settlement to End Medicare Improvement Standard, MGH Community News, November 2012), a court settlement has been reached to discontinue the practice of routinely halting services such as physical therapy for Medicare patients once the patient reaches a plateau. The court will hold a Fairness Hearing on January 24, 2013 "to determine whether the settlement agreement is fair, reasonable and adequate," after which it is hoped that the judge will issue an order permanently approving the settlement agreement. Medicare will then need to clarify their guidance to contractors. Can the Jimmo Settlement Agreement help now? Yes. The Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now. We have been hearing from many sources that they are still being denied coverage based on the Improvement Standard. We continue to think that coverage should be available now for skilled nursing or therapy necessary to maintain an individual’s condition. This is particularly true since the government itself states that the Settlement Agreement clarifies rather than changes the law. We encourage people to appeal denials even if they think the appeal will be futile because, once finalized, the Settlement Agreement will provide a review under the proper standard for all claims that are denied on the basis of the Improvement Standard after January 18, 2011 (the date the Jimmo case was filed). Use the Center for Medicare Advocacy’s Self-Help Packets to help understand proper coverage rules and contest a Medicare denial for outpatient, home health, or skilled nursing facility care. Include a copy of the Settlement Agreement. Key pages and sections of the Agreement are highlighted in yellow in the version on the Center’s website. Explain that the Settlement confirms, and the government agreed, that skilled services are covered when they are required to maintain a patient’s condition, or prevent or slow further deterioration. Providers and Medicare decision-makers should be pushed to change their approach based on the Settlement – now. When it is fully implemented, the Settlement Agreement will result in new manual provisions explicitly covering maintenance nursing and therapy, and formal education of adjudicators and providers. But there is no reason not to make the argument now. Perhaps some decision-makers can be educated before the Settlement’s education campaign begins. And if denials persist, people will be entitled either to re-review later on in the Settlement process or at a higher level of review in the regular Medicare appeals process. What Can Beneficiaries Do If They Were Denied Care Under the Improvement Standard? The Jimmo settlement establishes a process of "re-review" for Medicare beneficiaries who received a denial of skilled nursing facility care, home health care, or out-patient therapy services (physical therapy, occupational therapy, or speech therapy) because of the Improvement Standard that became final and non-appealable after January 18, 2011. Shortly after the federal district court approves the settlement, CMS will announce how beneficiaries can invoke the re-review process. The Center for Medicare Advocacy will post information about the re-review process on its website. For more information visit the Center for Medicare Advocacy website: http://www.medicareadvocacy.org/medicare-info/improvement-standard-2/
Medicare Reminder: Medicare Advantage Disenrollment PeriodThe Medicare Advantage Disenrollment Period (MADP) occurs every year from January 1 to February 14. During this time, you can switch from your Medicare private health plan, also known as a Medicare Advantage plan, to Original Medicare. Mental Health coverage protections under the Affordable Care Act are stronger than many realize. Title I, section 1302 defines "essential health benefits," those services which every single health insurance policy, beginning on January 1, 2014, must include and cover to qualify as health insurance in the United States. There are ten listed services, and number five is: "Mental health and substance use disorder services, including behavioral health treatment." Today, and until 1/1/2014, the inclusion of mental health services in health insurance is optional. Many states, not all, require it -- but those state mandates don't apply to the majority of large employers who self-insure. In 2008, Congress passed a law to require "parity" or equality of treatment for mental health care -- but that law only applies to employers who choose to offer mental health services, not to those who don't, and doesn't apply to employers with 50 or fewer workers. The ACA changes all that, and that's not all. As David Mechanic explains in a 2012 article in the journal Health Affairs: "The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions." -See the full blog post “Mental Health and the ACA” on Boston.com… Cited in/linked from: HEALTH CARE WEEKLY UPDATE, Health Care for Massachusetts, Barbara Roop & John Goodson, December 21, 2012.
As part of a plan to address an estimated $540 million mid-year budget gap, Gov. Deval Patrick earlier this month slashed spending by $225 million and asked the Legislature to allow him to unilaterally reduce unrestricted local aid to cities and towns by 1 percent. Senate budget chief Stephen Brewer told the State House News Service that he did not sense an appetite within the Legislature to grant the governor local aid-cutting powers. Lawmakers are scheduled to return to Beacon Hill in January, when the governor’s proposal will await their attention. A few of the accounts affected by the cuts are: -Adapted in part from PATRICK CUTS SPENDING BY $225 MILLION, WILL SEEK POWER TO CUT LOCAL AID, By Michael Norton and Matt Murphy, STATE HOUSE NEWS SERVICE, http://www.statehousenews.com. Supplemental State Budget Request At the same time the (9C) cuts were announced (see accompanying story), the Governor also submitted a supplemental budget request . This request to the Legislature includes a request for increased funds for the Emergency Assistance program (Line Item 7004-0101, $39 million) and the HomeBASE program (Line Item 7004-9316, $5.3 million). Both programs are expected to exhaust existing funds before the end of the fiscal year without an infusion of cash. - From Early December News: Implementation of New Shelter Regs, FY'14 Budget Hearings, FY'13 Budget Cuts and Requests, and More , Kelly Turley, Mass. Coalition for the Homeless, December 05, 2012. Treaty for Disabled Rights Falls Short in Senate US Senate supporters fell five votes short of the 66 needed for ratification of the international pact known as the UN Convention on the Rights of Persons with Disabilities — hailed by advocates as a human rights effort to transform how nations across the world treat those with long-term physical, mental, and intellectual impairments, particularly children who face a future of bleakness because of their disabilities. The treaty had already been approved by the European Union and 125 countries, including China and Russia. -See the full The Boston Globe article …
One Third of Americans Postpone Care Because of Cost The percentage of Americans who postponed care during the previous 12 months because of cost is at an all-time high — 32% — since 2001, when Gallup began tracking this statistic. In 2001, just 19% of Americans put cost before care. This problem of delayed treatment, which is bad for patient health and physician revenue alike, is not limited to the uninsured. Thirty percent of the privately insured are care postponers compared with 21% of Americans receiving Medicare or Medicaid and 55% of the uninsured, according to Gallup. Americans who put off medical care because of cost are more likely to do so when beset with a serious health condition (19%) than a nonserious condition (13%), a pattern that has generally held steady since 2001, Gallup reported. The company drew its findings from telephone interviews with a random sample of 1015 adults in November. -See the full summary: One Third of Americans Postpone Care Because of Cost. Medscape. Dec 17, 2012. Opinion: The Affordable Housing Crisis The precious few federal programs that provide rental assistance to the nation’s poorest and most vulnerable families are already underfinanced. These programs provide decent housing for about only a quarter of the low-income families who qualify for them. And with nearly nine million households teetering on the verge of homelessness, the country clearly needs more support for affordable housing, not less. Congress has not treated these housing programs kindly in recent years. Between 2010 and 2012, financing fell by about $2.5 billion, or nearly 6 percent, although some of this was mitigated by one-time measures, like spending from reserves. President Obama’s budget for the 2013 fiscal year is not much of an improvement; given inflation, Congress would have to increase appropriations just to keep treading water, when, in fact, what the poor in this country need is a significant jump. These families skimp on food and medical care to make the rent and tend to move often, making it difficult for their children to be successful at school. They are also more prone to homelessness, which is traumatic for them and extremely costly for the municipalities that run shelters. Yet even as the need for affordable housing has grown, such units have disappeared. Over the last two decades, for example, private landlords have removed more than 200,000 apartments from subsidy programs so that they could raise rents. And, faced with weak federal support and no money for repairs, the local housing authorities that manage federally supported developments have boarded up or torn down more than 150,000 units. -See the full The New York Times opinion piece for ideas and proposals… -Cited in/linked from: NYT Editorial: The Affordable Housing Crisis, Kelly Turley, Mass Coalition for the Homeless, December 05, 2012.
APA Rejects Personality Disorder Diagnosis Changes in DSM 5The American Psychiatric Association (APA) recently voted down proposed changes in the way Personality Disorders will be classified and diagnosed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5). The change will not appear in the first version of the manual scheduled for release in May 2013. Personality Disorders are currently broken into 10 separate diagnoses in the DSM-IV. However, the DSM-IV diagnoses are much criticized for being subjective and vague and there is so much overlap (comorbidity) between the definitions that many patients are diagnosed with more than one personality disorder while others are given the catch-all diagnosis Personality Disorder - Not Otherwise Specified (PD-NOS) A working group developing new definitions for the DSM-5 tried to resolve this by eliminating some diagnoses and developing a scale of traits. However the new system was criticized as being too complex for practical everyday use. The early decision to drop Narcissistic Personality Disorder (NPD) from the list of disorders led to so much criticism that NPD was later added back in. However, the controversy did not subside and the changes were dropped. At issue is the problem that the neurological causes for personality disorders are not well understood. Some clues to the root causes for personality disorders have been seen by researchers using functional magnetic resonance imaging (fMRI) but this is not settled science or widely available today. Source articles:
The Holiday-Suicide Link Is a Myth The widely held belief that suicides spike around the holidays is false, and the media may be partly to blame for fueling this ongoing misconception, according to the Annenberg Public Policy Center (APPC). Since 2000, the APPC, based at the University of Pennsylvania, in Philadelphia, has been tracking reports in the media about the notion that more people commit suicide during the end-of-year holidays than at other times during the year. The APPC tracked daily suicide rates to determine whether they are higher during the holiday season. On the basis of official suicide deaths in the United States, the months of November, December, and January typically have the lowest daily rates of suicide in the year, they report. "Despite what many believe, the holiday-suicide link is truly a myth," the APPC says. There is clearly a seasonal pattern to suicide rates, with rates highest usually in the spring and summer months. After efforts by the APPC to debunk this misconception, the number of such stories dropped, and stories debunking the myth grew in number, they report. However, their latest look at stories that ran during the last holiday season (2011-2012) shows that the number is once again rising. The proportion of stories making the holiday-suicide link is "once again at the same high level as in 1999 (76%)," the APPC notes in a statement released this month. The APPC cautions that stories in the media that make suicide appear more common during the holidays may encourage vulnerable individuals to consider it. According to the Centers for Disease Control and Prevention, suicide is the tenth leading cause of death in the United States. It is the second leading cause of death for people aged 15 to 25 years and the fourth leading cause of death for those between the ages of 25 and 44 years. It is now a greater cause of death than traffic fatalities. -See the full article summary The Holiday-Suicide Link Is a Myth. Medscape. Dec 17, 2012.
Parents with Disabilities at Risk for Discrimination, Loss of Custody A report from the National Council on Disability finds that parents with physical or mental disabilities have a greater risk of losing custody of their children. The study says that the U.S. legal system needs to provide more support for these parents. See the report- Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children.The among other findings, the report notes that parents with disabilities are more often denied adoption, and women with disabilities may be denied fertility treatments. -Listen to, or red the transcript of Parents with Disabilities At Risk for Discrimination, Loss of Custody on NPR’s Talk of the Nation, broadcast November 27, 2012.
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