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Redefining the Role of Government as it Affects the Lives of People with Disabilities
December 05, 2011

Disability Policy Consortium

December 5, 2011                         Calendar of Events  
Disability Policy Consortium  Weekly Update

 

Dear Bill,

 

Good Morning! 

This issue includes a couple of important messages. 
The first is that the December 9, 2011 EOHHS FY13 Budget Hearing has been moved to the Agganis Areana details below.

The second item of importance is the first section of a Question and Answer between Sen. Richard Moore (D-Uxbridge), Senate Chair of the Joint Committee on Health Finance and EOHHS Secretary JudyAnn Bigby.
The question asked were originally posed by Disability Advocates Advocating our Health Care Rights to Sen. Moore and his staff.

Elsewhere, VSA Arts brings us the first Holiday celebration.

 

 

 

Bill Allan

Disability Policy Consortium

wfallan@dpcma.org| 617-542-3822

 

Editorial:  Game On 

 

The Patriots just beat the Colts, 31-24, but the outcome 

was never in doubt.   This Friday EOHHS will hold the second half of it's annual budget hearing on FY13 expenditures.  Last week I name it the game  a "Charade".   Like all games, both teams must show up or else the game is a default.

 

Since this event caps the public discussion until the Governor releases House 2 in late January, here are a couple of things to watch if we are going to be able to handicapped the budget deliberations.

 

Will the advocates for Adult Day Health show up in numbers or do they think they made their case strong enough in FY12 that it will hold in Fy13?

 

Do the advocates for disability services have any new arguments to support continued funding since the old ones haven't been working too well.

   

What impact will new Assistant Secretary Christine Griffin have on agency allocations?

 

 Will the A&F budget analysts be in the Agannis Arena? Or, will it be the usual "our minds are made up, don't confuse us with facts"?

   

Bill Allan Signature
 

On the Calendar: EOHHS Change!

 

The EOHHS hearing in Boston next Friday, 12/9 has been moved to:

Agganis Arena at Boston University
Francis D. Burke Club Room
925 Commonwealth Avenue
Boston, MA 02215-1204

The hearing will be tentatively divided as follows:
2:00 to 3:00 Disabilities and Community Services - MCDHH, MCB, MRC, DDS
3:00 to 4:00 Health Services - DMH, DPH, DHCFP, MassHealth
4:00 to 5:00 Veterans, Elder Affairs, Soldiers' Homes
5:00 to 6:00 Children, Youth and Families - DCF, DYS, ORI, DTA

Please note this is a tentative schedule, subject to change.  There will be a rolling sign-up for witnesses.  If a lot of witnesses show up to testify on the Children, Youth and Families matters, EOHHS may not have enough time to hear all witnesses as the hearing will end at 6:00 PM and DTA budget items are last on the agenda.  We may be able to sign you up ahead of time, as long as you can arrive by 5:00 PM. 

 
Advocates Corner: Occupy Amherst
 
...your question about where are pwd in the Occupy movement?

 

 I am a pwd (though not a visible disability) and I was at an Occupy in Amherst (my kids told me I was in a video made by local MoveOn folk of the event) during the Nov 17 day of support...I did not have time to go to the Occupy Boston event that day.

 

Love to hear other answers.  It's tough to arrest people in wheelchairs but it's done.  With all the police violence we should be getting new members in 'the club" soon.

 -- Martina Carroll 
 
Advocates Corner: Moving On
 
Anita Albright
Director
Office of Healthy Aging and Disability
Massachusetts Department of Public Health

Anita Albright, a friend, colleague and strong advocate for people with disabilities with the Department of Public Health announced her resignation this week.  She has accepted a position with Blue Cross Blue Shield as the Manage of Medicare Advantage. 

 It has been an honor to work with you over my six years at MDPH.  Together we have made giant advances in our efforts to support older adults and people with disabilities to live healthier lives, though we all know there is much more to be done.  My work with internal and external partners at MDPH has emphasized for me the value of partnerships and the power of committed people working toward common goals.  
 
We first met Anita six years ago when she started her work by bringing together a broad spectrum of people representing disabilities to plan her first application to the Center for Disease Control for funding.  Since then, our paths have often crossed in both Public Health and community settings.

The community will miss her leadership. 
 

On the Calendar:VSA Holiday Crafts 

 

Handmade Holiday  

November 29, 2011 - January 6, 2012 

Reception 
Friday December 9th, 4 - 7pm
Meet the artists and enjoy light refreshments.
89 South Street, Suite #101
Boston, Massachusetts 02111

VSA Massachusetts' Handmade Holiday is the state's alternative craft and art exhibit featuring the work of local crafters & artists of all abilities.  Handmade Holiday features weaving, printmaking, jewelry, felting, painting and much more!

Felting Workshop
Thursday December 8, 5:30 - 7:30pm
Ariel Rosenblum will be leading a workshop to teach participants how to felt ornaments in various shapes. We are asking that each felter make an ornament to take home with you and make an ornament to donate to our Handmade Holiday Exhibit. Suggested Donation: $10  RSVP: kati@vsamass.org

 

 

Calendar: Health Care Quality and Cost Council Annual Meeting
 


Friday, December 16, 2011
   

 

The Massachusetts Health Care Quality and Cost Council (HCQCC) Annual Meeting will be held on Friday, December 16, 2011 in Worcester, Massachusetts. Members of the public, including but not limited to, advocates, consumers, providers, employers, health plans and the press, are encouraged to attend.

 

The topic for this years meeting is "value based purchasing in health care." The meeting will feature a presentation by Jeff Selberg, Executive Vice President and COO, Institute for Healthcare Improvement.

UMASS Medical School
Hoagland Pincus Conference Center
222 Maple Avenue
Shrewsbury, MA

Please register here: Register for HCCC Annual Meeting

 
from the Net: DISCHARGE RIGHTS

 

NAMHI MASSACHUSETTS

 

KNOW YOUR DISCHARGE PLANNING RIGHTS FROM

MASSACHUSETTS LICENSED PSYCHIATRIC UNITS!

  

Every patient of a locked psychiatric unit, regardless of coverage, has a right to effective and proper

discharge planning. Depending on insurance coverage, some patients may have additional discharge

planning protections. Below please find a listing of rights pertaining to hospital discharge planning.

  

FOR MASSHEALTH RECIPIENTS:

* The discharge professional (or the person responsible for formulating discharge plan) should

screen you within 24 hours of admission.

  

* Facility staff should commence discharge planning and activities within 72 working hours of

admission.

  • If you require additional care and resources after discharge, a written plan must be developed.

FOR MEDICARE RECIPIENTS:

* Your discharge plan, developed by your provider, must be in writing!

  

* Your plan must also be "individualized and comprehensive.¨ Therefore, your discharge plan must

be particular to your condition with specific treatments and goals outlined.

  

FOR ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE:

  

* The Massachusetts Department of Mental Health acknowledges that facilities should make every

effort possible to avoid discharge to a shelter or onto the street. However, in situations where patients with mental illness are being released onto the street, these discharge plans should include arious recommendations and alternative resources for those patients.

  

* If you are 18 or older and without a legal guardian, you must give your informed consent, which involves providers informing you of the proposed course of treatment, all alternatives to that proposal, and the risks involved in accepting either the proposed course or the alternatives.

 

Likewise, you must provide consent to the proposed discharge plan. When a guardian had been

appointed, the guardian must provide informed consent.

  

* You have rights under the American Hospital Association's Patients Bill of Rights:

  

* "The patient has the right to make decisions about the plan of care prior to and during the

course of treatment and to refuse a recommended treatment or plan of care to the extent

permitted by law and hospital policy and to be informed of the medical consequences of

this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.¨

 

* You should be actively involved in formulating your discharge plan and should remain in discussion with your providers to be part of the planning process.

  

* If you have a legal guardian, that person has a right to be involved in treatment and discharge

planning.

  

* If you are a minor (under age 18), a parent or other person with legal custody has the right to be

involved in treatment and discharge planning.

  

* If you are an adult (age 18 or over) and want a family member or other person to be involved in

your treatment planning or discharge planning, you or your legal guardian must give consent to

the facility for that person to be involved.

  

* In situations where healthcare proxies are involved, it may state explicitly in the healthcare proxy

document that the proxy can be involved in discharge planning. However, even when the

document does not explicitly state this, if the document states that the proxy can be involved in

general healthcare decisions, discharge planning may still be included.

  

WHAT TO DO IF A MEDICAL FACILITY HAS VIOLATED THESE RIGHTS:

* If you think that your rights of those of your loved one have been violated, complaints can be

made to the following entities:

  

o Unit staff: Since locked psychiatric units are licensed by the Massachusetts Department of

Mental Health, every psychiatric unit has to comply with the DMH complaint process

which provides that complaints may be filed with unit staff.

  

o Human Rights Officer: Every psychiatric unit must have a Human Rights Officer who

also must accept complaints and who can assist patients in writing complaints.

  

o Director of Compliance/Quality Assurance: Each facility will also have a director of

compliance/quality assurance or the equivalent. NAMI can help you find out who this

person is. You can complain to this person as well.

  

o If a Medicare recipient OR a MassHealth recipient, you can send a letter complaint to:

Madeleine Biondolillo, MD

Division of Health Care Quality

99 Chauncy Street

Boston, MA 02111

  

Additional suggestions:

File your complaints in writing if possible. Keep a copy of your complaint for yourself. Keep also the

name of the staff you filed the complaint with and the date you filed it.

Other individuals, such as family members, may file any of these types of complaints on your behalf.

  

IF YOU PREFER, YOU CAN ALWAYS CONTACT NAMI AND WE WILL HELP YOU WRITE

AND SEND THE APPROPRIATE COMPLAINT LETTERS.

  

NAMI Massachusetts

400 West Cummings Park, Suite 6650

Woburn, MA 01801-6528

(781) 938-4048

 
 
News from the Net: Drug Use

 

The AP (12/1, Perrone) reports, "Government inspectors told lawmakers Wednesday that Medicare officials need to do more to stop doctors from prescribing powerful psychiatric" medications "to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings." The antipsychotic medications are prescribed to treat "people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the US to pacify aggressive behavior related to dementia." But these medications "can also increase the risk of death in seniors, prompting the Food and Drug Administration to issue multiple warnings against prescribing the drugs for dementia."

        

"Nursing homes should be held accountable for inappropriately dispensing antipsychotic" medications "for Medicare beneficiaries and pay back the Part D program for those misused medicines, Department of Health and Human Services Inspector General Daniel Levinson said Wednesday," CQ (12/1, Bristol, Subscription Publication) reports. "The Centers for Medicare and Medicaid Services (CMS) is emphasizing non-pharmacological interventions for patients who did not have a diagnosis of psychosis or might not be candidates for the drugs." Patrick Conway, chief medical officer and director for the CMS Office of Clinical Standards and Quality, stated that "in addition to improving education for providers, prescribers and patients' families, the agency is strengthening current rules and eliminating conflicts of interest that may influence prescribing."

 

Bloomberg News (12/1, Wayne) reports, "Medicare improperly paid about $116 million in the first half of 2007 for prescriptions filled in nursing homes for a class of drugs called atypical anti-psychotics, Daniel Levinson told the Senate Committee on Aging in a hearing today." The "anti-psychotics include AstraZeneca Plc (AZN)'s Seroquel and Eli Lilly & Co. (LLY)'s Zyprexa."

 

 
News from the Net: Duals Dialogue    

(Editors Note:  Between the time the questions were asked and answers the terminology changed.  The Centers for Medicaid and Medicare (CMS) started calling the managed care agents Integrated Care Organizations (ICO) rather than Integrated Care Entities (ICE).)



The Commonwealth of Massachusetts

Executive Office of Health and Human Services

One Ashburton Place, Room 1109 Boston, MA 02108

 

JUDYANN BIGBY, M.D. Secretary

 

To: Chairman Richard T. Moore

From: Secretary JudyAnn Bigby, M.D.

Date: November 2,2031

 

RE: Request for Additional Information on the Proposed Integration of Medicare and Medicaid for the Dual Eligible Population  

your questions submitted to EOHHS in regards to our efforts to integrate Medicare and Medicaid services for the Commonwealth's dual eligible population, please find responses to these questions below.

 

1. Enrollment: There is a concern that because of the complex needs of the dual eligible population, particularly those with two or more major diagnoses, passive enrollment into Integrated Care Entities (TCEs) will lead to interruptions in care, reduced quality of care, and confusion. Why is EOHHS seeking passive enrollment when the SCO model is voluntary? While the scale of SCO membership is not high, quality of services and savings remains high. How will EOHHS effectively move 100,000 people into a delivery system that currently does not exist? Is EOHHS going to have an active fee-for-service system for people who want to get out of an ICE plan?

 

CMS has clearly and strongly indicated that they will be making investments in proposals that can generate significant volume for the duration of the three-year Demonstration period (2013 - 2015). The SCO experience is specifically an example of how an opt-in enrollment policy would not generate the volume and the data necessarily to impact system change, to be scalable and sustainable, and to generate sufficient evaluation data for CMS. It is also critical that we be able to attract high-quality bidders; many provider and insurance oriented groups have publicly stated in Duals Open Meetings that it will be challenging for them and organizations like them to make the kinds of investments and commitments necessary without some assurances that they would be able to enroll sufficient volume. This becomes even more important where we wish to provide choices between organizations for members to enroll with.

 

EOHHS has incorporated many suggestions from stakeholders to develop an enrollment process that will mitigate and minimize disruptions and allow for informed, supported decisions. Neutral/impartial enrollment brokers will be contracted by MassHealth or the federal government to provide clear, useful, accessible information about plan options to members. MassHealth will also be leveraging community organizations to support member choice. Members will be given sufficient time and information to make a choice, including sufficient advance notice and information, opportunity to select a specific plan or FFS, and timely confirmation of choice or auto-assignment before coverage begins.

 

Members will be able to easily determine whether their current providers are included in an ICO's (previously known as "ICE") provider network, MassHealth will reach out to providers currently serving dual eligibles ages 21 to 64 and the ICOs will outreach to members' preferred providers and caregivers. ICOs will be required to continually enroll providers that meet network requirements. Members who need to or wish to select new or different providers will have clear information about those providers. Members will be able to change plans or disenroll at any time, and will have clear, useful, accessible information available to them about how to change plans.

 

EOHHS will be phasing in enrollment over a period of several months, and we are buildmg time and resources into our implementation planning to provide members with accessible information, decision support, and sufficient time for consideration before they make enrollment decisions. While the delivery system is not yet aligned and organized as it will be with procured ICOs, we expect, and will encourage, that many of the same providers that our members use will be available to them from within the new networks. EOHHS will be requiring organizations to outreach to the providers that members have care relationships with, and enroll them into provider networks wherever possible.  

 

Organizations will also need to make careful transitions and provide continuity of care from existing providers and care plans where new arrangements need to be put into place.

 

EOHHS will be maintaining an active fee-for-service system for people who wish not to enroll, or who wish to disenroll from an ICO plan. We truly believe that we will be providing such a better value through the ICO plans with care coordination, integrated benefits, and expanded diversionary behavioral health and community support services that most members will also see the ICOs as providing superior value to what they have today.

 

Click PDF or Text to read the rest of the Questions and Answers:   Original PDF    Scanned Text  

 

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