June 2014

June 29, 2014

The slow, multi-year process of restoring full dental benefits to over 800,000 adults with MassHealth coverage is moving forward another step.

Sunday evening, the House and Senate conference committee filed their proposed state budget for Fiscal Year 2015, which starts on Tuesday.

Back in 2010, benefits in the MassHealth adult dental program were significantly cut. Currently, the only oral health services covered are cleanings, extractions, and fillings. Fillings were restored in two stages - first the front teeth in 2013, and for all teeth this year.

The budget language, to be voted on Monday, adds a requirement that "The executive office [of health and human services] shall implement adult denture coverage not later than May 15, 2015."

While we advocated aggressively for full restoration, dentures are a logical next step in adding benefits. For people who need them, dentures play a critical role in promoting overall health and wellness. During the 10+ month wait for the benefit to start, more people will suffer serious (and expensive) health impacts due to lack of complete oral health care. But this outcome is real progress, and we thank our long-time oral health legislative leaders, including Senator Harriette Chandler and Representative John Scibak for championing the cause. 

    --Brian Rosman

June 29, 2014

[below is a guest post by Jennifer Bonanno, Communications Director of More Than Wheels, a nonprofit car-purchasing program that helps struggling individuals and families break the cycle of poor financial decision making by using the car buying process to catalyze lasting change, financial stability and control]

Health reform, along with demographic changes, are rapidly increasing the demand for home and community-based care. As cost containment laws and regulations in Massachusetts, such as Chapter 224, are transforming the delivery method of healthcare, stakeholders  are recognizing that reliable and affordable transportation for the direct care and health workforce is KEY to successful health reform implementation.  Unfortunately, for many in this growing workforce, dependable transportation for patient care and career advancement is beyond reach.  Home care and health services employers describe three transportation-related barriers:

  1. Challenges to Providing Quality Care

Quality of care suffers when a direct care worker is unable to get to her client on time or at all, due to the lack of reliable transportation. Appointments are missed, caregivers are stressed and distracted, and consumers are left with inferior levels of care.

  1. Increase in the Total Costs

Transportation issues are increasing employer costs through loss of productivity and difficulty retaining good workers. Mental stress increases significantly when a worker does not know if she will be able to get to her job on time or at all. Transportation uncertainty results in employee absenteeism, tardiness, and staff turnover, forcing employers to turn to costly temp agencies to fill the gap or not be able to fulfill a request for services.

  1. Difficulty in Training & Career Advancement

Workers are derailed from career advancement due to unreliable transportation limiting their training opportunities. This barrier inhibits employees from meeting certification requirements and professional growth opportunities. It impedes employers from promoting from within and forces them to bring in new employees, resulting in a significant cost.

These obstacles aren’t new to the direct care and health workforce, but what is new is the speed at which the industry is transitioning to at-home care.  There is also a rise in new jobs opening up to low and moderate income workers, who often lack financial literacy and have credit issues, making them ineligible for auto loans.  

Take Terrie’s story from the Boston Globe for example:

Sixty-three-year-old Terrie Cherry, a personal care attendant, crisscrosses Worcester up to seven times a day on the local buses to reach her patients. She rides Route 6 in the morning, and if the bus is late, as it was twice last week, so are the clients and patients she helps care for when she prepares them for their doctor’s appointments. “I could walk it if it wasn’t all hills, and taking a cab means I’d have to give up at least one hour’s pay,” she said. “It is becoming a big problem.”  

Although Terrie is just one personal care attendant, the transportation challenges facing many workers is the same.

More Than Wheels provides a solution to overcome unreliable transportation issues in Massachusetts.  We are initiating pilot projects in several communities in the Commonwealth to better understand the cost and impact unreliable and unaffordable transportation has on the home care and health care sectors.

By collaborating with employers we are able to:

  • Increase awareness of options regarding transportation and money management
  • Incorporate our transportation and financial management knowledge into current workforce training programs
  • Offer our car-buying program services
  • Test innovative employer-paid benefits that address transportation issues at a reasonable cost

For more information about the workforce transportation challenge and More Than Wheels, please contact Jennifer Bonanno.

June 25, 2014

HCFA is extraordinarily pleased with the recent decisions by the Patrick administration supporting health care for people needing gender therapy care. The new policy will allow transgender people across the state to access appropriate mental health care, hormone therapy, and other transition-related care.

The state made several related decisions in this area last week. DOI issued a bulletin advising health insurers that "denial of coverage for medically necessary treatment based on an individual's gender identity or gender dysphoria by any carrier is sex discrimination that is prohibited under Massachusetts law." In addition, MassHealth will soon cover gender affirmation surgery and other treatment for gender dysphoria as part of its benefits. The administration also pledged to work with the state's Group Insurance Commission to take similar steps in ensuring equal access to gender therapy services for the state employees it covers.

The press statement from Mass Equality includes our comments:

Amy Whitcomb Slemmer, executive director of Health Care For All, states, “This is an immensely important step forward in ensuring that health coverage meets an individual’s full range of health care needs. We commend the Administration for again putting Massachusetts in the vanguard among states as a leader in health equity for everyone, and providing a model other states can use to improve access to care for all residents.”

Monday, the Boston Globe ran a moving portrait of 60-year Cape Cod musician Rikki Bates, who was denied MassHealth coverage for gender reassignment surgery earlier this year. “It’s like my life’s dream coming true, really,” Bates is quoted as saying. “I never thought this day would come.”

We congratulate the adminstration for this progress, and will continue to work closely with DOI and MassHealth as this new policy is implemented.

   -Brian Rosman

June 25, 2014

Our fiscal year ends on June 30th – there are just five days left to help Health Care For All this year!

calendar - 30th

 

Please help us provide health care education, enrollment services, and advocacy that the people of Commonwealth deserve. In order to continue the important work we do and improve the quality and accessibility of health care for all Massachusetts residents, we depend on your generosity.

We invite old and new friends to consider making a gift today.

If you have not already made a donation to our annual fund and appreciate the work we do, please help out.

 

To make a tax-deductible donation:

• Click here to make an online donation
• Mail a gift to: Health Care For All, 30 Winter Street, Boston, MA 02108
• Dial a pledge at 617-275-2926

Celebrate and Remember
What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to give today!

Online Giving Made Easy!
Make a contribution to HCFA via Network for Good. Simply select Health Care For All as your charity of choice.

Matching Gifts
Many corporations provide a 1:1 matching gift for their employees who donate to nonprofits. Please contact your Human Resources department today.

Monthly Donations
Support HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today!

Workplace Giving
Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC # 111147) and the City of Boston Employees Charitable Campaign (COBECC #2015).

Thank you again for considering a donation to Health Care For All.  Because of your generosity, HCFA’s good work can continue.

Olivia's Story

June 19, 2014

The One Care program provides coordinated care to adults with disabilties who are eligible for both Medicare and Masshealth. As of May, the program covers over 13,000 people. One Care goes beyond MassHealth and Medicare to proivde expanded services and a person-centered philosophy. It demonstrates how changing how health care is paid can change how care is delivered.

Health Care For All serves as the front door to the One Care Ombudsman Office. As the One Care program continues to grow in enrollees, we are hearing from consumers who have experienced the benefits of coordinated care. Members direct their care and have access to programming and services through an Independent Living Long-Term Services and Supports Coordinator (IL-LTSS). The range of services offered often facilitates an individual receiving home-based versus institutional care.

Community Catalyst produced this video that shares the profound difference an Independent Living Long-Term Services and Supports (IL-LTSS) Coordinator made in the life of One Care member Olivia Richard. IL-LTSS Coordinators play an important role in the One Care model allowing members to actively participate in their community, maintain their health, independence, and dignity.

Please watch this and share it with others as it serves as an example of how care coordination can deliver a higher quality of life to consumers by addressing medical and community support needs.

  -Carla Wahnon

June 18, 2014

Health Compass home page

MA Health Quality Partners today launched its new consumer website with quality data for pediatric and adult primary care practices across Massachusetts.

The website, called Healthcare Compass (http://healthcarecompassma.org), provides both clinical quality data and patient experience data. The website is easy to navigate and comprehend, with options to dive more deeply into data for those who want to, and provides links to many useful resources, websites, and tools.

While more work is needed to help consumers learn about an individual physician (the site reports data at a practice level), we appreciate MHQP's work to develop a consumer-oriented website that can used for making health care decisions.

  -Deb Wachenheim

June 17, 2014

SQAC Meeting Title SlideThe Statewide Quality Advisory Committee (SQAC) met on Monday.

The meeting included a presentation by a Department of Public Health working group looking at quality measures relating to palliative care and end-of-life care. This was followed by a discussion of the measures that were submitted to the SQAC for its annual process of considering measures to add to the Standardized Quality Measure Set (SQMS).

The committee agreed with the recommendations of the SQAC staff to move 35 measures along for further evaluation, including the 5 measures nominated by HCFA. The 35 measures fall into the categories of End-of-Life Care, Patient-Centered Care, Pediatric Care, Behavioral Health, Patient Safety, Leapfrog measures, and 3 CMS Hospital Measures.

HCFA's 5 nominated measures fall under End-of-Life Care (Consumer Assessment and Reports of End of Life, Family Evaluation of Hospice Care, Family Evaluation of Palliative Care) and Patient-Centered Care (Use and Quality of Shared Decision Making, Active Patient Engagement). The Lewin Group will evaluate the 35 measures and present their results and recommendations to the SQAC at the next meeting, which is September 22, 9-11am, at CHIA.

The meeting closed with a discussion about what area of specialty care to pick for further research into measures specific to that speciality. OB care was chosen as the initial specialty area of focus. Materials from Monday's meeting are posted on the SQAC website

June 16, 2014

Public News Service story on dental studyDental health issues were in the spotlight today both on a state and national level.  Looking at Massachusetts, the Public News Service released a story about the increase in dental-related visits to emergency rooms following cuts in adult dental care in MassHealth in 2010. The story is based on a recent study by the BU School of Dental Medicine, which found that following custs in MassHealth dental care, ER visits for adults increased by 14%, and growth among those 55 to 64 years old jumped an astonishing 50%.

HCFA’s own Oral Health Policy Coordinator, Courtney Chelo, was quoted, stating that patients seeking dental care in the ER are provided temporary pain relief but are, “not necessarily getting into a dental chair and having whatever problem directly addressed.”

Also included is Senator Harriette Chandler who has been fighting to restore oral health funding to MassHealth.  Sen. Chandler sponsored a Senate budget amendment to restore MassHealth coverage for dentures.

The article highlights the need to continue to fight to restore MassHealth adult dental care benefits to provide dental care to thousands of people across the state.

Nationally, NPR’s The Diane Rehm show today discussed dental health across the country. The topic of conversation focused on increasing access to dental care, promoting prevention and education, reducing costs and increasing multi-disciplinary team-based care.

Diane Rehm was joined by a 3 experts on her show, including Dr. Louis Sullivan, former secretary of Health and Human Services under George H.W. Bush, and president emeritus of the Morehouse School of Medicine.

Much of the conversation discussed the differenced between dental health access and insurance coverage compared to medical health, focusing on the overall health problems caused by this inequity.  Dr. Sullivan set the tone of the conversation, stating, “We know that we can do better. Dental health is part of overall good health.”

The program included questions from the public, mostly voicing frustrations over lack of dental coverage and high costs. One caller, who did not have dental insurance, shared his own story of spending years suffering from dental pain and sleepless nights while he saved up enough money to pay for the care that he needed.  He stated, “I don’t understand why [dental care] isn’t considered as necessary as access to medical care.”

You can hear the show on Diane Rehm’s website.

   - Melinda Rossi

June 16, 2014

Summary of agenda for Connector Board meeting 6-12-14

Last Thursday, the Health Connector Board met to discuss progress with the “dual track” plan to fix the eligibility and enrollment system; vote on work orders with business vendor Dell; and vote to repeal employer-related regulations.

Jean Yang began with her Executive Director’s report, with a preview of the July board meeting. In July, Connector staff plan to come to the Board with:

  • Preliminary Seal of Approval recommendations (which plans to be sold through Connector for 2015)
  • 2015 Navigator Program update
  • FY2015 administrative budget

Due to the tight timelines and high level of work ahead in the summer, Yang is also considering scheduling an August board meeting. Yang concluded her report by stating that the Health Connector is “making more progress than we have for a very long time.”

The update on the website and enrollment systems is here, and other materials are available on the Connector website, under Leadership • Board Meetings.

 

Health Insurance Exchange (HIX) Update

Coverage Extensions
As we reported in an earlier post, the Commonwealth received permission from federal officials to extend Commonwealth Care and temporary MassHealth coverage through December 31, 2014.

Dual Track Process: hCentive and FFM
Maydad Cohen, the new special assistant to the Governor for project delivery, overseeing the eligibility and enrollment system fixes, delivered his first presentation to the Connector Board. Cohen provided updates on progress with hCentive and the Federally Facilitated Marketplace (FFM) for Connector coverage and introduced a section about the MassHealth eligibility system. For this coming open enrollment period, which starts November 15, 2014, Connector and MassHealth eligibility and enrollment processes will be separate – however, the systems will have to communicate with each other. The vision is to implement an integrated MassHealth-Connector eligibility system in time for open enrollment in 2015.

Connector Slide: Progress made with the hCentive track for a State Marketplace 6-12-14

According to Cohen, implementation of the hCentive product is going well. The key risk areas that remain include:

  • Federal data hub integration;
  • Vendor integration (particularly Dell for enrollment and billing); and
  • Aggressive timeline and staffing challenges.

Roni Mansur is the Connector lead on the hCentive track. He stated that the Connector plans to release hCentive version ‘1.0” on June 30th and present the product to CMS in early July, an important check point that will help determine whether the Connector can use the state-based solution through hCentive or default to the FFM for the next open enrollment period.

The Connector plans to release a version of hCentive every 30 days. The state wrap (ConnectorCare) will not be included in the initial release, which is focused on core Affordable Care Act (ACA) requirements. The Connector plans to build in the capability to do ConnectorCare determinations for the July 30th version 2.0 release.

Nick Fontana, a Connector staff member, and staff from hCentive provided a live demo of what the “of the shelf” hCentive application process looks like. This application used was a slightly modified version of the federal streamlined application.

Ashley Hague is the Connector lead on the FFM track. Hague said that the Connector is also making significant progress. Should the Health Connector need to use the FFM for the next open enrollment period, the Connector would be considered a “Supported State-Based Marketplace.” Essentially, this means that while the Connector would use the FFM’s eligibility system, it would still have authority over other Exchange decisions, such as which plans to offer. One particular area of challenge is integrating ConnectorCare into the FFM will be a major challenge, as the FFM does not allow for customization.

Medicaid Eligibility Platform (MEP)
Kristin Thorn, Director of Medicaid, provided an overview of the work MassHealth is doing to revamp the previously-built HIX system to make eligibility determinations for residents potentially eligible for MassHealth. This system will be needed with both the hCentive and FFM. MassHealth is focusing on developing this system for the Medicaid MAGI population, meaning people who are required under the ACA to receive and eligibility determination based on Modified Adjusted Gross Income (MAGI), a new income methodology. In order to minimize the scope of work, MassHealth is focusing on 24 of the 180 possible MassHealth eligibility categories. People with disabilities and seniors will largely be determined for coverage outside of the MEP. Currently, the MEP is making program determinations with an 80% accuracy rate.

June 12, 2014

(cross-posted from Community Catalyst's Health Policy Hub blog; Health Care For All testified with Community Catalyst this week at the hearing on this proposal and will continue to work on this issue.)

With Boston Pride celebrations coming up this weekend, Bostonians have at least one reason for preemptive celebration! Yesterday, the Boston City Council unanimously passed a new ordinance that would ensure that the City only contracts with health insurance providers that offer comprehensive benefits for transgender people. This means that transgender Boston city employees will no longer face discrimination in trying to access a health plan that covers their health care needs.

Boston is the first city in the Commonwealth of Massachusetts to pass such a policy, though we’re following in the footsteps of a handful of other municipalities, including San Francisco (CA), Portland (OR), Seattle (WA), Rochester (NY), and Washington D.C. We’re hopeful that the city-specific ordinance will help influence other municipalities around the state as well as the Commonwealth at-large in supporting comprehensive access to care for all of us living here in Massachusetts. This ordinance is the first step for us to forge a public path for health equity, making the statement that no form of discrimination belongs within our borders.

Community Catalyst, Health Care for All, and Health Law Advocates made the decision to alter our own health benefits package this past year, noticing that our previous carrier excluded transgender health care coverage. Listed among the collection of the PPO and HMO plans’ exclusions were:

• Transsexual surgery, including related drugs or procedures
• Services deemed not medically necessary by the insurance carrier.

Despite the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American College of Obstetricians and Gynecologists, and the World Professional Association for Transgender Health clearly stating that transition-related care such as mental health services, hormone therapy, and appropriate reconstructive surgeries are medically necessary for transgender people, many insurance carriers’ policies suggest otherwise. As a result, the burden of proof lies upon the consumer, requiring an uphill battle for those seeking time-sensitive transition-related coverage.

But, we’re making momentous progress here in the Commonwealth.

With this new policy, Boston is standing as a leader for the state, and other municipalities on this issue. By offering comprehensive transgender coverage to Boston’s employees, we really are instilling a strong sense of equity in our city’s practices, and a strong sense of health security for those serving our community. A hearty round of ‘thank yous’ go out to the Boston City Council and the members of the Transgender Benefits Workgroup for making this new policy come to fruition. We’re looking forward to continuing to work with the AIDS Action Committee, Eastern Bank, MassEquality, GLAD, and Health Law Advocates as we work with the state to make additional progress in supporting equitable health insurance coverage for all populations.

   -Emily Polak, Community Catalyst

 

June 12, 2014

Connector: Commonwealth Care and Temporary MassHealth Extended Through Dec. 31, 2013

At this morning’s Health Connector Board meeting, Maydad Cohen, the new health reform implementation czar (official title: Special Assistant to the Governor for Project Delivery), announced that Massachusetts received approval from federal CMS officials to extend the Commonwealth Care and temporary MassHealth coverage programs through December 31, 2014.

Over 100,000 residents are enrolled in Commonwealth Care and 227,000 residents are receiving temporary MassHealth coverage. People who are getting coverage through these programs will have their coverage automatically extended through the end of the year.

A full account of today’s Connector Board meeting will be posted here soon.

  -Suzanne Curry

 

Suzanne Curry

June 11, 2014

Conference logoMasspro (a health quality improvement organization), MITSS (Medically Induced Trauma Support Services, supporting patients, families, and clinicians who have been affected by an adverse medical event), and the MA Coalition for the Prevention of Medical Errors  are cosponsoring a day-long forum highlighting healthcare organizations that are thriving in a changing healthcare environment, including by engaging patients and families as partners. The event is taking place in Framingham on June 25, and costs $75 to attend.

The conference will include sessions looking at the human side of healthcare, and on how to best support clinicians and staff.

They have posted the agenda, the breakout session details, and a description of keynote sessions, including the morning keynote by Dr. Timothy Johnson. Click here to register.
  -Deb Wachenheim

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