Letter to Executive Director Mark Miller

Dear Mr. Miller:

Is the Medicare Payment Advisory Committee’s (MedPAC) recent draft recommendation removing two classes of medication – antidepressants and immunosuppressants – from the Six Protected Classes under the Medicare Part D program?

Removing these two drug classes would violate the longstanding policy of ensuring that patients have access to the full range of life-saving and life-enhancing medications and restrict a physician’s ability to prescribe a regimen that is both effective and considerate of the challenges that co-morbidities and medication interactions can pose.

I urge you to reconsider removing both antidepressants and immunosuppressants from the Six Protected Classes, and to instead enshrine the protection of all six classes as a pillar of the Medicare program going forward. PROTECT the protected classes!

Thank you for your attention to this important issue.

Sincerely,

Kathleen Powers, AAS

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Body Bag Project: Mental Health Movement

 

An excellent write-up of the Mental Health Movement’s Body Bag’s Project is found at http://streetwise.org/2016/03/body-bags-project/!

Many people do not realize the need for public mental health safety nets to help persons with mental illness stay out of prison, stay out of nursing homes, become homeless and/or not suicide.

So far, the Chicago Department of Public Health (CDPH) dragged their feet since Obamacare came out and STILL has not contracted to any managed care organization. The Community Mental Health Advisory Board that consists of clinic users and shuttered users continues to ask the important safety net questions and advise the CPDH on proven effective methods for treating the pandemic spread of mental illness. The closed clinics need reopening because not all of the neediest areas are covered: there are only 5 clinics on Chicago’s south side and only 1 on Chicago’s north side. All of this while Cook County Jail teems with persons with serious mental illness.

Bodybag Flyer

Illinois Home Services Program Attempts to Cut Lifeline Services to Persons with Disabilities

Home-Care-WorkerAs an advocate concerned about the Home Services Program (HSP), I find capping IP services hours egregious! HSP, critically important to thousands of people with disabilities across the state of Illinois, ensures that everyday HSP customers receive care from their Individual Providers (IPs).
Capping the hours that IPs can work at 40 will mean that people with disabilities will not be able to access personal care assistance. In most places throughout Illinois, HSP consumers cannot find, hire and keep decent good IPs.
Parents, siblings and other relatives who act as IPs, with whom Illinois desires to cut work hours below 40 hours, jeopardizes financial and supportive IP, positive outcomes and quality of life. Until more effective policies emerge for persons with disabilities, this reduction of IP hours becomes cumbersome, undo-able and strict.
HSP customers and IPs deserve flexibility, not rigidity. Please eliminate the cap hours a week is too harsh and will put too many people’s lives at risk.
Photo from http://blog.abbeyspanier.com/wp-content/uploads/2012/08/Home-Care-Worker.jpg

STATE OF OUR STATE: ALLIANCE IN ACTION on the ROAD TO RECOVERY 

By James Jones – Metropolitan Family Services
January 26, 2016

This morning we are embarking on a trip to try to save stable and productive lives, at least in Illinois. Cutting the programs for mental health facilities in this state shows an apathy that could very well cause a travesty that could also prove tragic. We have seen on buses, on the streets, and even in programs for help, people with oftentimes severe mental disturbances that could be potentially dangerous. This is why this trip is so mandatory to many of us who need these programs just as much as any with a physical impairment. If someone had a broken arm or shattered ribs, you would want them to get medical attention immediately. But a broken psyche or shattered nerves, then what would you do? The answers to that do not come as easily because of the intricate workings of the mind. This is just one of the many reasons we must protest in numbers against the cuts to our communities, to stem the illnesses before they grow out of control.
Also, the stigma attached to mental illness is far greater than the physical could ever be. Derogatory terms for mental illness are plentiful, many used in everyday conversation. If the same would be said about someone in a wheelchair or crutches, it would be deemed cruel and distasteful. But mental illness, at whatever level it would be, is fair game for ridicule unless it is hushed up, swept under the rug, or in lower levels, ignored. These have not been effective methods to achieve mental wellness.
That is why this Road to Recovery to Springfield is so important; to have our voices heard. If no one speaks out there will be no attention or empowerment, and without these, there can be no recovery. We must stress the need for these programs clearly, distinctively, and in no uncertain terms. We have the right to stand firm and express that we cannot take this lying down. Remember that many would most likely be closer to stability had it not been for previous cuts; those many who could have lived productive lives and helped more clients in need by giving their stories as examples. We have gained great strides in the education and treatment of mental disturbance and made far too much progress to stagnate or regress. We will not slow down as we approach the finish line, or listen to nay-sayers who say we will not make it or try to cast us idly aside.
This is why it is so invigorating to be part of such a huge assemblance of different mental health services coming together for such a needed common cause, battling for the soul of Illinois. Not only did we experience unity in numbers but truth in numbers, which is one of the most powerful strengths of all, giving us a renewal of spirit in case the foibles of red tape leave us frustrated and downtrodden.
It is also ironic that I felt a sense of mass therapy with so many groups converging on Springfield showing that we care enough to come to the heart of the state to let our feelings be heard, if not heeded. It is a gamble if our showing will make a difference…Whether or not the [legislators] actually do anything legislatively, they can’t say they didn’t hear our voices loud and clear. That the funding for our facilities cannot be sliced to the bone. They cannot ignore that we made a bold statement in the state capitol. We pitched straight, now it’s up to them to catch.

Mpowered | Government Affairs & Strategic Initiatives
Metropolitan Family Services
One North Dearborn, Suite 1000 | Chicago, IL 60602
P: 312-986-4227 (direct) | F: 312-986-4334
www.metrofamily.org | jenningt@metrofamily.org

Press Release

FOR IMMEDIATE RELEASE

 

Contact: Monica Trevino, 773.573.8667

 

35th Ward Alderman Carlos Ramirez-Rosa says Mayor Needs To Go A Step Further and Reopen Mental Health Clinics

 

“I’m glad that Mayor Emanuel announced common-sense reforms to the Chicago Police Department, but the Mayor’s job is far from complete. Ending violence and promoting safety requires a comprehensive approach that ensures Chicagoans have the health services that prevent conflict. Mayor Emanuel needs to reopen the mental health clinics he shuttered in 2012.”

 

Alderman Carlos Ramirez-Rosa is a lifelong Chicagoan who has dedicated his life to public service. As a community organizer, former congressional caseworker, and now Thirty-Fifth Ward Alderman, Carlos has always put our families and our neighborhoods first.  For more information about the 35th Ward please visit www.aldermancarlosrosa.org

 

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My testimony about the Department of Human Services (DHS) Proposed Changes on 08/26/15

082615 DHS Hearing

August 26, 2015

Ms. Tracie Drew, Bureau Chief
Bureau of Administrative Rules and Procedures
Department of Human Services
100 South Grand Avenue East
3rd Floor, Harris Building
Springfield IL 62762

Dear Ms. Drew:

Re:

Department of Human Services, Proposed Rules, 39 Illinois Register, pages 7301 est seq., May 29, 2015

As a Medicaid recipient of medical assistance and home services, I face a serious threat to my rights because the State of Illinois’ proposed hearing rules impose many overwhelming barriers for me to maintain my medical assistance benefits. I feel that the proposed rules would make it

difficult for me to appeal the Department of Human Services (DHS) decisions to terminate or deny my medical benefits, especially if I personally need to appeal a denial or termination of benefits.

Initially, I do not understand why

these proposed changes are necessary.

Secondly, because the hearing officer will impose the order of call of witnesses as she/he deems necessary, this two-hour hearing may be inadequate for me to fairly present my views in five minutes. I come here today to express my concerns.

Request for accommodation

To accommodate my disabilities, I request that DHS allow a 60-day appeal period, the historical time period, and that any delay caused by my medical condition may cause me medical and economic hardship. I suggest that a 30-days appeal period insufficient.

I request an accommodati

on for my disabilities that DHS offers me the option of an in-person hearing.

Benefits protection under federal law

The proposed rules are overwhelmingly complicated and confusing, and conflict with federal statutes and regulations that protect my eligibility rights for my Medicaid and Home Services benefits programs below noted.

Adequate notice

The proposed rules do not require adequate notices about termination or denial of my benefits. I suggest that DHS add language to the proposed rule to require a clear statement for the reason of its action. I suggest that the DHS does not delete the requirement that all written notices bear the same date as the date of their mailing and delivery.

DHS will not apprise me that I may request a hearing before a date of action (not the date of notice). I suggest that DHS gives me enough time to respond properly ‎to my notice. I suggest that it offers me a means to comment.

In the past, DHS sent me a notice of termination that did not allow me to respond to my resident agency service office in a timely manner, i.e., the respondent office was not

my assigned office. I did not have enough time to acquire the information requested. This made me spend 6½ hours travel and waiting time, and three office visits to submit my missing documentation. I needed to leave one office due to my long wait in an office with permeating fecal smell. After a two-hour wait, I had to leave to avoid vomiting. I returned to a fresher office the next morning. There were 250 people waiting before me, so I had to wait again. The condition of the two offices that I entered I found filthy, bug-infested, moldy and unhygienic. My visit to 5050 N. Broadway caused me to have an asthma attack.

With the proposed deletion of the word “adequate” in notices suggests that DHS thinks that notices can be something less than adequate, yet still be legally sufficient. If I receive a vague notice and think that it does not affect my benefits, I will lose my benefits. By the time I understand that DHS terminated my benefits, my appeal time and benefit payment pending appeal may have expired. I will again lose my needed medical benefits while I reapply and appeal.

Hearing judges

At a minimum, due process requires that hearing officers must be impartial. I suggest that the DHS include qualifications for hearing officers for all hearings, and specifically that hearing officers be licensed attorneys. An impartial hearing officer holds appeal hearings to determine fairly ‎the areas of agreement and disagreement. I strongly suggest that DHS replace the deletion of “unbiased” with “impartial” throughout the rules.

Free access to records

The proposed rules do not assure me free and timely access to my records for appeals. I suggest that DHS avail me of my full case record in the least burdensome manner.

I suggest that DHS not withhold my “confidential information” because that would restrict my review of my case record during an appeal process. DHS should not withhold anything in my case record for my review during the appeal process. Confidentiality is my choice, privilege, and not that of DHS.

Reasonable access to hearings

The proposed rules changed the hearing locations where I may not have reasonable access. I understand that long-term medical assistance, assigned to Chicago or Decatur, does not reimburse travel and associated costs. I could not afford to travel to Decatur.

The Bureau of Hearings (BOH) has the capability of taking appeals requests by telephone and has been doing so for many years. The proposed rules will not accept medical assistance appeals by telephone. This does not make any sense to me.

Due process

The proposed rules do not provide me with due process. I am entitled to administrative hearing procedures that have integrity and are fundamentally fair. The proposed rules require that only I may personally file a medical assistance appeal. I suggest that DHS permit my Power of Attorney agent, guardian or an authorized representative, and/or legal counsel to file appeals on my behalf. I suggest that the appeal form request attachment of my Power of Attorney document or other authorization form.

There is no rule requiring DHS to make the written appeal form readily accessible, although it requires acceptance of only written medical assistance appeals. There is no rule requiring the department to make the written appeal form readily accessible. Presently, I can only find the appeal form online and I do not always have Internet access. I suggest that DHS enclose a blank appeal form with any notice that initiates my appeal rights.

The proposed rules say that if I “improperly” request an appeal, then the BOH will advise me of the proper appeal process. I do not understand what this means. What is an “improper” appeal? Do I lose time to file my appeal? May I bring witnesses, pursue any argument without undue interference, submit evidence to establish all pertinent facts and circumstances, and question or refute any testimony or evidence, and include the opportunity to confront and cross-examine adverse witnesses?

I commend DHS for proposing to make an electronic recording of the hearing proceedings available to me at no cost and if such recording is not available, to make a transcript available to me at no cost.

Confusing deadlines

The proposed rules require that I provide evidence to DHS at least 3 days ( business?) days in advance of my medical assistance appeal or the hearing officer may not consider that information. This worries me because I have limited access to email, fax and/or scanned required documents. Will DHS provide me with free legal representation? What happens if my correspondence or records are lost?

The rules do not consistently specify identify deadlines; whether due dates are counted in calendar days, business or working days. I suggest that time be consistently stated throughout the rules.

Benefit payments pending appeal process

Presently, I understand that a provision exists that I am entitled to continued benefits pending appeal if I appeal in a timely manner. I cannot locate it in the proposed rules.

Burden of proof

The proposed rules require me to prove that DHS’s action is wrong, rather than requiring DHS to identify why the action is right. Because of the above-mentioned lack of reassurance for me to access to my records for the appeal, I could be unable to provide proof. This seems distinctly unfair to me. Since DHS has full access to my records located in various agency data stores, warehouses, databases, prisons, telephone records, emails and at different agency locations, I think that DHS is in a better position to provide the burden of proof.

If an attorney does not represent me, I do not have the wherewithal to defend my position within the network of governmental agency policies and procedures. Given my limitations and the inaccessibility of DHS staff, it is unfair to place the burden of proof on me.

Task-based services

Now that DHS moved to task-based staffing and special processing units, my accessibility problems have increased. With the task-based system, trying to talk to someone about my case in my DHS agency office requires me to recapitulate my entire DHS history at every encounter; affords me with little or no timely availability of my records; and, completely loses consistency of my issues with a different task worker every time. I need a caseworker to follow my case, not a task worker.

While task-based staffing and special processing units provide efficiencies for DHS, in the appeal context, it has the potential to overwhelm me and force me to abandon my meritorious appeal rather than try to navigate the system. I feel so discouraged.

In summary, these proposed rules will cause wrongful termination of my entitled benefits that will cause serious threats to my health and economic security. I implore you to review these proposed rules and their due-process violations, barriers, and uncertainties, through my eyes, as an at-risk citizen. Accordingly, I suggest that DHS withdraw the proposed amendments and refile them with adequate descriptions and reasons for every proposed change, addition and deletion in the rules.

Sincerely,

Kathleen A. Powers, A.A.S.
Northside Action for Justice, Member of the Board
The Alliance for Community Services, Steering Committee Member
Medicaid Recipient082615 DHS Proposed Changes Testimony

C4 closes May 31, 2015 and need for mental health services safety net in metropolitan areas

http://www.wbez.org/programs/morning-shift/2015-04-27/morning-shift-c4-closing-111943

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