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December 20, 2011 
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Disability Policy Consortium Weekly Update
Dear william,
It's 12 degree outside and the temperature is dropping. So much for spring weather we've had through November. Winter is here....at least on mid-coast Maine on a Sunday night.
This issue has opportunities for all of you wishing to learn sign language or just learn about Deaf culture. Check out the calendar listings.
We are beginning a crucial time for the Integrated Care proposal being submitted by MassHealth to the federal government to provide managed care for people on MassHealth and Medicare. The next hearing is scheduled for January 4 at 10AM in the Transportation Building at 10 Park Plaza in Boston.
We're going to take next Monday off. Merry Christmas, Happy Chanukah, enjoy Kwanza, and above all, Peace.
Bill Allan
Disability Policy Consortium
wfallan@dpcma.org| 617-542-3822
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Editorial: Hearing v Listening
The December 16 EOHHS MassHealth hearing on the proposal for an integrated health care system for people on both MassHealth and Medicare (Duals) opened with a frequent phrase from the conveners: "we are here to hear what you have to say." It was echoed during the wrap up with a thank you to everyone for attending. There were also promises to take what people said seriously and that it will be reflected in the final submission to Centers for Medicaid and Medicare (CMS).
Hearing and listening can be two different experiences. Those of us who participated in the series of prior "planning meetings(1)" with representatives of the Patrick/Bigby Administration are skeptical when
we "hear" the phrase "we are here to hear what you have to say" because we have seen from experience that we are often not listened to on critical issues. For example, over the past 5 years advocates have said:
- The Olmstead Plan needs dates, responsibilities and allocation of funds to be a plan; otherwise it is a set of ideas (Olmstead Planning)
- People with disabilities need to be involved in all levels of emergency planning (Task Force)
- There is experience within the Independent Living Centers for getting people out of nursing facilities. Why invent a new system? (Money Follows the Bureaucrats Person)
The operative phrase in the prior processes and illustrated in the results was this: "This is the Administration's proposal". Meaning, of course, the Administration will decide what is best for the Commonwealth. The results we've seen so far include:
- an Olmstead Plan that has not seen any broad commitment to implementation(2),
- the 1115 Waiver process wasted 2 to 3 years planning including at least a year and a half of advocate time, only to die stillborn at One Ashburton Place,
- The 2008 Task Force Report on emergency planning was ignored when it was placed on the shelf , and
- Money Follows the Person committed to building a new system of nursing facility extraction at UMass rather than strengthening the work of the Independent Living centers.
What is the track record so far on the Integrated Care initiative for Dual Eligibles?
Yes, there has been a significant number of meeting with Administration planner and representatives of Disability Advocates Advancing our Healthcare Rights. The process has been dynamic, but the results remain mixed at this point in the process.
Here's what the some of the record shows from a reading of Duals application and the DAAHR objectives as discussed during those meetings. The complete report from DAAHR will be available soon. Nassira Nicola, BCIL, and Al Norman, Mass Home Care, contributed to this chart. We are particularly indebted to Nassira for her work.
DAAHR Principles EOHHS CMS Draft
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Voluntary Opt-In Enrollment
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Involuntary Mandatory Enrollment
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"community-based marketing systems created to provide Dual Eligibles with the information necessary to make informed choices"
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MassHealth will partner with ICOs and other vendors, advocates, state agencies, community agencies and other stakeholders to increase awareness of the Demonstration's benefits through a variety of media such as community forums, direct mailings, print and visual media, and advocate and provider forums" (C.i.c., p. 11)
The existing Customer Service Vendor has been identified as the primary marketing contractor.
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"freedom to disenroll from an ICE without prohibitive 'lock-in' periods"
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"The Commonwealth proposes that there be no lock-in period and that members may change ICOs within the Demonstration, or select the FFS option, at any time." (C.i.c., p. 10)
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"all quality measures and their results should be publicly available on the EOHHS website, and in alternate formats upon request."
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Not addressed
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"access to services within an ICE should be equal to or broader than in other delivery models" (P1)
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"The delivery system must include medical homes and a broad network of providers, and provide the full range of Medicare and Medicaid services, long term services and supports." (P3)
- "include 'those services covered by Medicare Part A and Part B; [...] services provided under MassHealth standard coverage, [...] services covered under the home and community-based services waiver program; and services necessary for the treatment of mental health or substance abuse.'" (P3
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"MassHealth will require ICOs to have provider networks with the capacity to provide enrollees, either directly or by subcontracting, the full continuum of current Medicare and Medicaid covered services, as well as the additional services covered under the Demonstration." (C.i.b., p. 8)
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"All Medicare-covered Part A (inpatient, hospice, home health care), Part B (outpatient), and Part D (pharmacy) services, and all Medicaid State Plan services will be included in the capitated payment to the ICO." (C.ii.b., p. 14)
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"The ICO shall not have a direct or indirect financial ownership interest in an entity that serves as an independent care coordinator."
(conflict free care coordination)
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The Medical Home will provide a Care Coordinator to serve on the enrollee's care team." (C.ii.b., p. 13)
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Inclusion of 24/7 housing with supports
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Not included; nursing remain default housing provider
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"choice of care manager, choice of each and every clinician, choice of treatment, and choice of the ICE itself"
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When selecting an ICO, members will have information about each ICO's provider networks and whether they include the member's current providers. Because this is a statewide Demonstration, MassHealth is optimistic that most of the providers with whom members have existing relationships will be included in the provider networks of one or more of the ICOs." (C.i.c., p. 10)
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Hearing vs Listening?
The results on Integrated Care is spotty so far. Dental services will be included which will be a strong marketing factor. Person-center language is included, but not adequately defined throughout the proposal. Voluntary enrollment is "too slow" for EOHHS and more important, for CMS.
Regarding the differences between DAAHR sand EOHHS, the reasoning from MassHealth seems to be that this proposal is being written with the intent of obtaining CMS funding. Then, the official thinking goes we'll be in a position to do the right thing once we're funded.
This Administration's track record doesn't allow too much confidence that the final result will be much different from what is on paper now.
Footnotes:
1 The Community First Olmstead Plan, the 1115 Waiver, Systems Transformation Grant, The Task Force Report on Emergency Preparedness and People Needing Additional Assistance, and most recently Money Follows the Person.
2 The Administration has maintained its commitment to close Fernald and other facilities even as it invests big money in a new state mental hospital in Worcester.
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Please join you fellow advocates at the next public hearing on Integrated Care on January 4 in the Transportation Building in Boston at 10 AM.
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Advocates Corner: Notes from Duals
the December 16 hearing on Integrated Care for Dual Eligibles.
Bill Allan, December 18, 2011
Robin Callahan opened the hearing with introductions saying that the EOHHS representatives "were hear to listen".
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Janet Shaw (Stavros) testifying on December 16
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Testimony opened with a series of advocates (James Orlando, Sharon Saxe, Laurie Johnson) from the Northeast Independent Program talking about the need for American Sign Language services being included in the Integrated Care services model. It was pointed out that ASL is a recognized language (Krista Brown) and should be the same priority as Spanish or Portuguese.
Paula Callanan testified that some NILP clients experiences with Senior Care Organizations were not good. A major problem was that these same clients lost their contact with NILP as a result of SCO enrollment.
Florette Willis, DPC health planner and M-POWER Coordinator expressed fear of a reduction in long term support services for her mother. Her mother is now cared for by Florette, Florette's sister, and personal care services. Any reduction of of PCA services for her dual eligible mother would result in more responsibilities on the two sisters or admission to a nursing facility.
Dennis Heaphy, a dual eligible testified as an individual of his prior experience with managed care. His urologist visits normally took 20 minutes because the urologist knew his needs. Once in managed care, the visits stretched to two hours and he left the visit bleeding for two days.
Joe Bellil from Easter Seals supported DAAHR principles and stressed voluntary opt-in as vital to real person centered care - people should want to opt-in. He also asked for simpler marketing literature, respect for disability etiquette, meeting the ADA requirements such as with accessibility scales and interpreters, and having a contractual relationship with community support services. Joe also said that he didn't see: employment & recreation included in the proposal which were vital to a person's overall health.
Nick McNamara from Center for Living and Working was the first of a chorus of voices who encouraged Integrated Care entities to maintain long term services on contracts and to maintain the personal care program.
Paul Spooner added his voice to many who expressed fears that the current PCA program would disappear under Integrated Care when the providers used their own personnel to provide services. This would medicalize the model of services and consumers would lose their independence. He called for CommonHealth members to be "carved out" of the Integrated Care proposal.
Bill Allan, DPC, pointed out the weakness of the proposal on addressing the Americans with Disabilities Act. "Simply making a checkbox on compliance will not cut it for ICO's.
Michael McGuiness, Evelyn Kaufman, & Ruthie Poole expressed concern over loosing the momentum in the mental health community that has developed in recent years by the recovery movement and the use of "peers" in recovery work. As Ruthie put it "I picture large insurance companies trying to run recovery learning center and I just want to cry".
Al Norman representing Mass Home Care read twelve points of concern such as services in the least restrictive environment, independent conflict free care coordination, and the opt-out provisions. He linked the Integrated Care proposal to the Governor's stated objective to do away with fee for service medicine. Supposedly, Integrated Care members will have the right to quit at any time but will not have an option other than another managed care entity. He likens it to a medical version of the song Hotel California - "you can check out anytime you want - but you can never leave."
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On the Calendar: ASL Classes
DEAF, Inc. in Allston, MA is currently still accepting student registrations and money for the upcoming Winter Session of American Sign Language (ASL) classes.
Boston: Levels 1-5 classes begin the week of January 9, 2012, and are 1 night a week for 10 weeks.
New Bedford Office. Levels 1 & 2 classes begin the week of January 10, 2012, and are 1 night a week for 10 weeks for each class.
The classes are open to all adults who are interested in learning ASL or want to continue their studies in ASL. For more information on the classes, and to complete the registration form, you can go to:
. Or you can contact Jennifer Glinos,
jglinos@deafinconline.org
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On the Calendar: Deaf Studies
"Deaf Studies To-Go" is a collaboration between The Center for Workforce and Community Education and the Deaf Studies degree program at BCC. It is designed to outreach to and empower a variety of Deaf/HH community members and the ASL workforce. Deaf Studies To-Go offers seminars, known as appetizers, as well as, at least one main "course". Each seminar is one- three sessions, tailored to a specific audience, run by a qualified professional from the community and cost between $10 - $40.
Please go to www.bristolcc.edu/deafstudiestogo to register, read course descriptions, see times and other details. Please spread the word and please register!
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Calendar: Road to Interpreting
The Road to Deaf Interpreting, a training series for aspiring Deaf interpreters, has extended its application deadline and is looking for more participants. The program begins in March 2012. The new application deadline is January 3, 2012. For more information, please visit: http://www.northeastern.edu/riec/ |
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Calendar: Dual Hearing Changed
EOHHS wants to make you aware of a change in the time of the January 4, 2012 Public Hearing on the draft Demonstration Proposal for our dual eligibles initiative.
The hearing will go from 10 AM to 1 PM, instead of 9 am to 12 noon. The location remains the same - the State Transportation Building, Conference Rooms 2 & 3, 10 Park Place, Boston. |
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Calendar: Young Soloists
2012 VSA International Young Soloists Award
Application Deadline: January 31, 2012
Since 1984, the VSA International Young Soloists Program has been seeking to identify talented musicians who have a disability. The VSA International Young Soloists Award is given annually to up to four outstanding musicians, two from the United States and two from the international arena. The award provides an opportunity for these emerging musicians to each earn a $5,000 award, professional development opportunities, and a performance at the John F. Kennedy Center for the Performing Arts in Washington, D.C.
Eligibility Guidelines
Musicians with disabilities of any genre are eligible to apply, including, but not limited to: rock/alt rock; indie; pop; country/folk; jazz; R&B/blues; hip hop/rap; Latin; world; and classical. The age requirement for all participating musicians is 14 to 25 years of age at the time of application deadline (January 31, 2012).
Ensembles of two to five members are also eligible to apply for the award. The ensemble can be anything from a rock band to a chamber quartet to a drum corps. At least one member of the ensemble must have a disability, and all members must fit the age requirement noted above.
If you have any questions, please contact Nicole Agois, Education Program Manager at VSA Massachusetts
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News from the Net: Adaptive Ice
Adaptive Ice Sleds Available for Public Skating:
Many state-run ice rinks in Massachusetts have accessible ice skating sleds for people with disabilities to use on their own during public skating. Each sled has a set of hockey sticks with which you can propel yourself and there is at least one stroller bar at each rink to allow for being pushed too. Some sleds have more support - a higher back and chest strap for those
who need additional stabilization. Call in advance to ensure availability and find out anything else you need to know before you go:
Auburn - Horgan Rink: 508-832-7201
Cambridge - Simoni Rink: 617-354-9523
Boston: Hyde Park - Bajko Rink: 617-364-9188
Boston: North End - Steriti Rink: 617-523-9327
Boston: West Roxbury - Roche Rink: 617-323-9512
Brockton - Asiaf Rink: 508-583-6804
Franklin - Pirelli/Vets Rink: 508-541-7024
Greenfield - Collins/Moylan Rink: 413-772-6891
Holyoke - Fitzpatrick Rink: 413-532-2929
Jamaica Plain - Kelly Rink: 617-727-7000
Medford - Flynn Rink: 781-395-8492
Newburyport - Graf Rink: 978-462-8112
North Adams - Vietnam Vets Rink: 413-664-8185
Plymouth - Armstrong Rink: 508-746-8825
Revere - Cronin Rink: 781-284-9491
Springfield - Smead Rink: 413-781-2599
Taunton - Alexio Rink: 508-824-4987
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News from the Net:Position Open
Executive Director
Center for Living & Working, Inc., a consumer directed Independent Living Center located in Worcester, Massachusetts, whose mission is to promote and encourage independence for all people with disabilities, is searching for an experienced mission-driven professional to serve as the Executive Director. The position reports to the Board of Directors and is responsible for the organization's consistent achievement of its mission including its programmatic and financial objectives.
The Executive Director will lead and direct the overall operation of the agency in accordance with the guidelines set forth by the Board of Directors, government contract regulations, and our internal policies and procedures. Other responsibilities include maintaining excellent service quality and meeting corporate financial goals within established budgetary guidelines. The qualified candidate must have proven communication, administration, fund-raising and organizational skills with 10 years of progressive management experience in a relevant non-profit organization, including working with a Board of Directors. Bachelor's Degree or equivalent experience required, Master's preferred.
Applicants shall submit in electronic form (PDF) a letter of introduction with salary requirements and resume to OPSearch@centerlw.orgno later than January 31, 2012. Resumes will not be accepted by mail or fax. Qualified individuals with disabilities are strongly encouraged to apply.
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