Public Benefits Task Force

Agenda for November 1 Public Benefits Task Force meeting

Please join us on Thursday, November 1 at 9:30 am for our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Below is the agenda for the meeting:

 

  1. Welcome and Introductions
  2. 2013 Meeting Dates
  3. 2013 MD Legislative session
  4. COMAR 10.01.04.01B(3): “authorized representative” regulation
  5. Problems with DHMH Board of Review
  6. Medicaid Advisory Committee update
  7. Language Access issues – recent meeting with DHR
  8. Human Rights discussion
  9. Sept-Oct Clearinghouse Review issue on hunger/food access issues
  10. conferences and trainings
    1. Social Security training in conjunction with DC NLS
  11. case staffings

 

Medicaid Hearings

At the last PBTF we discussed how the MA fair hearing regulations are being interpreted by OAH to mean that legal counsel must enter an affirmative statement entering their appearance at the time the appeal is filed or face exclusion from the case for its duration.  Paralegals are being asked for a power of attorney or something in writing from the client naming the paralegal as the authorized representative.  Now, we need your stories if you have been affected by this practice.  The stories will be included in letters to DHMH and OAH advocating for changes in the regulations and in how the regulation is being interpreted.  

Please email a synopsis of your experience to Francine Hahn at fhahn@hprplaw.org no later than Wednesday, October 24.

Thank you!

 

Public Benefits Task Force meeting on Thursday, November 1

On Thursday, November 1 at 9:30 am, we will be having our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Please contact me at klang@mdlab.org by close of business on Wednesday, October 24 if you have any agenda items you'd like to add for the meeting. I'll circulate an agenda on Thursday, October 25 in advance of the meeting.

Health care reform: Caring about costs, too

From the Baltimore Sun opinion page:

Health care reform: Caring about costs, too
--------------------

Expanding health coverage won't be sustainable unless Maryland can reduce expenses by emphasizing primary care

By Joshua M. Sharfstein, Laura Herrera, and Charles Milligan

September 27 2012, 6:00 AM EDT

By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable health care to hundreds of thousands of individuals, families and small businesses. For our progress to be sustainable, however, the growth in health care spending must be slowed and brought into balance.

The complete article can be viewed at:
http://www.baltimoresun.com/news/opinion/oped/bs-ed-health-spending-20120926,0,5965015.story

 

Maryland Chooses Essential Health Benefits Benchmark

At the Sept. 27, 2012 Health Care Reform Coordinating Council meeting, Maryland chose the state employee health plan as the benchmark for Maryland's essential health benefits (EHB). 

See http://www.healthreform.maryland.gov/maryland-moving-forward/essential-health-benefits/ for the materials from the meeting and reports from the EHB Advisory Committee and Wakely Consulting.

Media coverage includes:

Md. health reform panel approves state health plan as benchmark in health care reform
 
 By Associated Press
 
 ANNAPOLIS, Md. — A Maryland panel working on implementing federal health care reform voted Thursday to use the state employee health plan as a benchmark for other plans that will be available to small businesses and individuals for two years, starting in 2014.
 
 To view the entire article, go to http://www.washingtonpost.com/local/md-health-reform-panel-to-vote-on-states-benchmark-health-benefit-plan/2012/09/27/e188303a-0862-11e2-9eea-333857f6a7bd_story.html?wpisrc=emailtoafriend
 

 

Maryland picks model for essential health insurance benefits
--------------------

Coverage includes acupuncture and pediatric dental

By Andrea K. Walker, The Baltimore Sun

September 27 2012, 8:57 PM EDT

Under national health care reform, insurance policies in Maryland will be required to cover acupuncture for pain management and chiropractic care in certain cases.

The complete article can be viewed at:
http://www.baltimoresun.com/health/maryland-health/bs-hs-health-reform-vote-20120927,0,7774664.story Maryland picks model for essential health insurance benefits
--------------------

Summary of Benefits and Coverage and Uniform Glossary

From the National Health Law Program:

Beginning today, consumers in the individual health insurance market will have access to a Summary of Benefits and Coverage (SBC) and a Uniform Glossary of medical and insurance terms to help them better understand their health insurance coverage and compare coverage between plans.  Individuals in group health plans will have access to these documents at the start of their next plan year or during the next open enrollment period beginning on or after September 23, 2012.

All insurance companies must use a standardized SBC template to provide consumers with the same information in easy to understand language. The SBC includes a list of benefits covered and the attendant out of pocket costs if received from in-network or out-of-network providers, as well as any limitations and exceptions to coverage.  Below is the official announcement from the Department of Health & Human Services (HHS) with links to the SBC template, the Uniform Glossary of Terms, and other related information.

 

FOR IMMEDIATE RELEASE

Monday, September 24, 2012

 

Health care law ensures consumers get clear, consistent information about health coverage

 Because of the health care law, millions of Americans will have access to standardized, easy-to-understand information about health plan benefits and coverage.  Insurance companies and employers are now required to provide consumers in the private health insurance market with a brief summary of what a health insurance policy or employer plan covers, called a Summary of Benefits and Coverage (SBC). Additionally, consumers will have access to a Uniform Glossary that defines insurance and medical terms in standard, consumer-friendly terms.

These tools will also assist employers in finding the best coverage for their business and employees. 

 “Thanks to the health care law, Americans will now get clear, consistent and comparable information when shopping for health coverage,” said Health and Human Services (HHS) Secretary Kathleen Sebelius.  “These new tools empower consumers to make informed decisions about their health coverage options and to choose the plan that is best for them, their families, and their business.”

 The SBC includes a new comparison tool, called Coverage Examples, which is modeled on the Nutrition Facts label required for packaged food, that helps consumers compare coverage options by showing a standardized sample of what each health plan will cover for two common medical situations—having a baby and managing type 2 diabetes. 

 The SBC will include information about the covered health benefits, out-of-pocket costs, and the network of providers. The glossary defines terms commonly used in the health insurance market, such as “deductible” and “co-pay,” using clear language.    

 Before today, people often lacked uniform and comparable information when shopping for coverage, often relying only on marketing materials to make decisions.  Starting this fall, consumers will receive the SBC free of charge and in writing from the consumers’ insurance company or employer.  This information can be requested at any time, but it will also be made available when shopping for, enrolling in or renewing coverage.  It will also be provided whenever information in the SBC changes significantly. 

 The SBC will be available beginning today for consumers in the individual health insurance market.  For enrollees in group health plans enrolling during an open enrollment period, it will be available during the next open enrollment period that starts on or after Sept. 23, 2012. For enrollees who enroll outside of an open enrollment period, it will be available at the start of the next plan year that begins on or after Sept. 23, 2012.

 The SBC and Glossary were developed in collaboration with the Department of Labor, Department of Treasury, consumer groups, the insurance industry, State Insurance Commissioners, and other stakeholders.

 For more information on today’s announcement, please visit:

http://www.healthcare.gov/law/features/rights/sbc/index.html

 For a sample SBC, please see: http://cciio.cms.gov/resources/files/sbc-sample.pdf

 For the SBC template, please visit: http://cciio.cms.gov/resources/files/sbc-template.pdf

 For the Uniform Glossary, please visit: http://cciio.cms.gov/resources/files/Files2/02102012/uniform-glossary-final.pdf

 

National Health Law Program- Health Advocates Conference

Date: 
Sun, 12/02/2012 - 8:00am - Tue, 12/04/2012 - 5:00pm

Maryland Legal Aid advocates who are interested in attending please complete a Level 2 Training request and submit to Reetta Gach at rgach@mdlab.org by Friday, October 12, 2012. 

 

Welcome to the on-line registration for the 2012 National Health Law Program's Health Advocates Conference.

 To register, sign in at:  http://www.nhelp.org/conf2012/login.php

 Your temporary Username/Email is: guest, and your password is: nhconf12

 After signing in, click on the "Register" link at the top left. Once you register you will use your email as your username

and a password of your choice. Please save this information as you will need this later on to retrieve workshop materials.

WORKSHOP DESCRIPTIONS

After you have logged in, you can view workshop descriptions by clicking on the sessions link on the upper left hand corner of the

web page.  Featured speakers include:

·        Cindy Mann, CMS Deputy Administrator and Director of the Center for Medicaid, CHIP Services

·        Vikki Wachino, CMS Director, Children & Adults Health Programs Group

·        Juliet Choi, Chief of Staff and Senior Advisor, HHS Office for Civil Rights

·        Anne Raish, Deputy Chief, Disability Rights Section, Civil Rights Division, U.S. Department of Justice

·        Tim Englehart, Centers for Medicare & Medicaid Services, Medicare-Medicaid Coordination Office, Director, Models,

Demonstrations and Analysis Group

·        Janice L. Genevro, Center for Primary Care, Prevention, & Clinical Partnerships, Agency for Healthcare Research & Quality

·        and many more!

LODGING

Lodging is provided at the Kellogg Conference Hotel at Gallaudet University. Rooms are double-occupancy. You will be assigned a roommate unless you pay a single supplement.

CLE CREDITS

You are responsible for applying for individual CLE credits in accordance with your state bar's guidelines. A certificate of attendance will be mailed to you using the CLE attendance sheet that will be provided at the conference.

SCHOLARSHIPS

NHeLP offers a limited number of full scholarships available for those relatively new to health advocacy. An application is included in this on-line registration.  Deadline for application is October 26th.

CONTACT INFORMATION

Should you have trouble with the on-line registration, or have any other questions or concerns, please contact Gabriella Rodriguez at (202) 289-7661 or rodriguez@healthlaw.org.

 

Location
Location Name: 
Kellogg Conference Hotel at Gallaudet University
Contact
Name: 
Gabriella Rodriguez, NHELP
Phone: 
202-289-7661

10th Annual Advocacy Conference

This year's advocacy conference is focusing on advocating for behaioral health needs of seniors and vulnerable adults.  This is a full day conference that includes breakfast and lunch for only $60 if you register by October 18.  Baltimore County Legal Aid is a member of the consortium that planned this conference.

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Agenda for September 6 Public Benefits Task Force meeting

Please join us on Thursday, September 6 at 9:30 am for our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Below is the agenda for the meeting:

  1. Welcome and Introductions
  2. New Assistant Director of Advocacy – Frank Natale
  3. Looking for PBTF co-chair
  4. Medicaid Manual available online
  5. COMAR 10.01.04.01 B (3) – “authorized representative” for purposes of filing appeal
  6. MA/SRT denial based on SSA determination
  7. Essential Health Benefits Benchmark
  8. Maryland Health Care Reform Coordinating Council
  9. Human Rights Lawyering Program
  10. Training and conferences
    1. Maryland Hunger Solutions Conference, Tuesday, October 16
  11. Case Staffings

 

 

Public Benefits Task Force meeting on Thursday, September 6

On Thursday, September 6 at 9:30 am, we will be having our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Please contact me at klang@mdlab.org by close of business on Wednesday, August 29 if you have any agenda items you'd like to add for the meeting. I'll circulate an agenda on Thursday, August 30 in advance of the meeting.

Maryland wins big grant for its insurance marketplace

By Meredith Cohn, Baltimore Sun

Maryland won its most significant infusion of federal money to launch its health insurance exchange, now formally called the Maryland Health Connection, state officials announced Thursday.

The $123 million will help build the marketplace, where hundreds of thousands of uninsured Marylanders will buy coverage under the federal health care law. It is expected to be running by October 2013, and insurance is slated to kick in the following January.....

http://www.baltimoresun.com/health/bs-hs-health-exchange-grant-20120823,0,2034015.story

See also:

To get updates on the Maryland Health Connection, go to www.marylandhealthconnection.gov; or text CONNECTED to 69302.

New MOLST regulations proposed

New regulations have been published in the Maryland Register for MOLST (Medical Orders for Life-Sustaining Treatment). See http://www.dsd.state.md.us/MDRegister/3915.pdf at p. 1087.  The new proposed regulations withdraw the regulations previously proposed in 2011, and include a new form.  Comments are due by September 10, 2012.  If anyone is interested in participating in comments, please contact Jennifer Goldberg at jgoldberg@mdlab.org.

Maryland Medicaid Manual - now revised and online!

Great news for everyone who handles Medicaid cases - the Maryland Medicaid Manual is now revised and online:

http://mmcp.dhmh.maryland.gov/SitePages/Medical%20Assistance%20Eligibility%20Updates.aspx.

No more need to navigate a book full of bad photocopies - both the updated manual and ongoing releases are included.  Yay!

 

Continuation of medical coverage for divorced spouses

 

Here is my question:

We concluded a divorce hearing on July 6, 2012 in which client received an absolute divorce, rehabilitative alimony, child support and the court also ordered that  the husband continue to provide medical insurance for Client and Child through his employer provided group insurance plan.

On Friday, August 1, 2012 , my client found out from Husband's employer, a large hospital, that the Husband allowed his insurance to lapse as of June 30, 2012, just before our divorce hearing.  Husband, who is pro se, denies this and claims he he renewed  the insurance.  No notice was given to my client of the lapse.

To be brief, the employer reinstated the Child on the insurance policy, but refused to reinstate Client. The employer is claiming that she is no longer a beneficiary.  I know that under MD Code Insurance § 15-408, allows for a divorced spouse to continue to be covered on the other party's health insurance. 

What is there any way to compel the insurance company to reinstate her?

 

Health Care. Women of Color Get It.

Date: 
Sat, 09/08/2012 - 8:00am - 4:00pm

From the Women's Coalition for Health Care Reform:

The Supreme Court affirmed Maryland's implementation of the Affordable Care Act, now it's time to get it right for women of color! Join Mildred Thompson, Director of PolicyLink Center for Health Equity and Place, and other dynamic speakers who will lead lively discussions on health care reform and it's impact on women of color and their families.

This conference is for you if you are:

  • Health care and public health professionals and students;
  • Community-based leaders, outreach and education workers and advocates;
  • Working on minority health and health disparities, cultural competency and health literacy issues, health policy; or
  • Tasked with implementing health care reform and monitoring its impact on communities of color in Maryland.

The conference flyer is here: http://www.mdhealthcarereform.org/storage/pdfs-and-docs/WOC%20Conference%20Flyer_7.26.pdf.

Click on the link below to register now!  The cost* is $25 for individuals, $10 for students, or organizations can purchase 5 tickets for $100.  Cost includes a continental breakfast, lunch and afternoon break.  For full conference details as they become available, please visit our website.

*A limited number of scholarships to cover the registration fee are available. If you need a scholarship, contact us.

Sponsor: 
Women's Coalition for Health Care Reform

Medicare Recipients To Get More Coordinated Care

From the Baltimore Sun: Medicare Recipients To Get More Coordinated Care
Four doctor groups across Maryland have been chosen by the federal Department of Health and Human Services for a program that aims to cut health costs and better coordinate care for Medicare recipients. … In Maryland, the doctor groups include: Accountable Care Coalition of Maryland LLC, located in Hollywood with 109 physicians; Greater Baltimore Health Alliance Physicians LLC, affiliated with Greater Baltimore Medical Center with 399 physicians; Maryland Accountable Care Organization of Eastern Shore LLC with 15 physicians; and Maryland Accountable Care Organization of Western MD LLC with 23 physicians.


http://www.baltimoresun.com/health/blog/bs-hs-health-care-groups-20120709,0,4220790.story

Report: Nation Isn’t Ready To Meet Elderly Patients’ Mental Health Care Needs

From Capsules, the Kaiser Health News blog:

http://capsules.kaiserhealthnews.org/index.php/2012/07/report-nation-isnt-ready-to-meet-elderly-patients-mental-health-care-needs/

By Christian Torres

July 10th, 2012, 3:46 PM

The U.S. is not prepared for the mental health needs of aging baby boomers, according an Institute of Medicine report released Tuesday.

A continued lack of specialists and other trained providers including primary care physicians and nurses will likely make it difficult for aging patients to receive treatment for depression, dementia and other conditions. In addition, some experts are concerned that the baby boomer population, which is a growing component of the nation’s older demographic, have an unaddressed problem with substances – namely misuse of prescription medications.

“There is a conspicuous lack of national attention either to preparing the health care workforce […] or to ensuring sufficient numbers of personnel for the rapidly growing elderly population,” the IOM committee wrote. It’s estimated that as many as one in five members of the elderly population had at least one mental health or substance use problem in 2010.

Meeting the growing needs of the elderly will require a coordinated effort among government agencies, professional societies, providers and even family caregivers, the IOM report said.

Government in particular can help by expanding training and loan forgiveness programs for health care professionals, the report suggests. It can also promote improved health care delivery through coordinated care models and through revisions to Medicare and Medicaid payment practices. For example, psychiatric case managers are not reimbursed by those programs, despite research showing that they can provide effective treatment for depression and substance abuse, said Peter Rabins, an IOM committee member and psychiatry professor at Johns Hopkins School of Medicine.

“We need to change mindsets” in both training and delivery of care, Rabins added. Health care providers, policymakers and others will have to recognize that mental health problems frequently run parallel to other medical issues and can lead to poor outcomes and higher costs.

Already, the government is pushing to improve mental health staffing for military veterans, an especially vulnerable subset of the elderly population. In April, the Department of Veterans Affairs announced that it would add around 1,900 psychologists and other staff.

Public Benefits Task Force meeting on TUESDAY, JULY 10

On TUESDAY, JULY 10, 2012 at 10 am, we will be having our next Public Benefits Task Force meeting in the second floor conference room in the Baltimore City office of the Legal Aid Bureau and via GoToMeeting. Please note the change in the meeting date from our normally scheduled date of the first Thursday of the month. Please contact me at klang@mdlab.org by close of business on Monday, July 9 if you have any agenda items you'd like to add for the meeting. I'll circulate an agenda on Monday, July 9 in advance of Tuesday's meeting.

ACA opinion is out

Woo hoo - ACA upheld!

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