Carmelo Gonzalez News Page 24

Home	My Business	About Me	My Book	My Photos
*My Poems*	My Documentaries	My Newspaper Articles	News To Know	My Links
MySpace	My Guestbook

Things that are going on that you might want to know.

115

The 2006 Child Abuse Prevention Web site

Source: Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services http://nccanch.acf.hhs.gov/topics/prevention/index.cfm

116

CASE FLASH: GETTING FULL COVERAGE

Ms. Q is a New York resident who has Medicare and Medicaid. Because she has both, Ms. Q is automatically eligible for Extra Help—the government low-income subsidy program for Medicare Part D—and was automatically enrolled in a randomly selected Medicare prescription drug plan. She received a yellow letter in the mail giving her the name and phone number of the plan she would automatically be enrolled into if she did not choose a different drug plan before January 1, 2006. Ms. Q made a list of all of her prescription drugs and called the drug plan in the letter to see if it covered her medications. She found out one of them, Klonopin (clonazepam), is not covered. Klonopin is a benzodiazepine, which is a class of drug categorically excluded by Medicare Part D drug plans. Ms. Q called her local State Health Insurance Assistance Program (SHIP) for help figuring out what she could do to get all her drugs covered.

The counselor informed Ms. Q that Klonopin is in a class of drugs called benzodiazepines. Benzodiazepines will not be covered by Ms. Q’s drug plan but will continue to be covered by Medicaid in New York State . After January 1, 2006, Ms. Q can use her Medicaid card at the pharmacy to refill her prescription for Klonopin. Most state Medicaid programs will continue to cover excluded drugs, check with your state program to see if your medicines will be covered.

To read more cases by subject, go to “Interesting Cases” on our web site at www.medicarerights.org/interestingcasesframeset.html.

Medicare Rights Center
1460 Broadway, 17th Floor
New York, NY 10036
Telephone: 212-869-3850
Fax: 212-869-3532

Web site: www.medicarerights.org

117

New Medicaid Home and Community-Based Programs Now Available. Information

Bulletin #102, 2/06

Despite Congress' numerous reductions in the basic Medicaid law

(recently enacted in the Deficit Reduction Act of 2005) that will

negatively affect low income persons, including persons with disabilities,

there are a number of provisions that disability advocates can take

advantage of to increase home and community-based services and to reduce

unnecessary institutional services.

First, State Medicaid Plans can now provide Home and Community-Based

services to eligible persons who need the services. This provision could

"Close the Front Door" and prevent unnecessary nursing home placement. For

example, in the MDS data as of September 31, 2005, nationally there were

173,194 (12.3%) persons in nursing homes who went directly from their

homes "with no home health services" before they were institutionalized.

Many of these persons were institutionalized in nursing homes before they

were provided or even offered home and community-based services. Your

State Medicaid department can correct his. Similarly, in the same MDS

data, nationally there were 806,831 (57.3%) persons placed in nursing

homes directly from an acute hospital. Many of these people were never

offered home and community-based services before they were sent away to

nursing homes? Your State Medicaid department can stop this.

The recent Congressional amendments could prevent many unnecessary

institutional placements in the future IF disability advocates together

with your MA officials respond creatively. Amend your State Plan to

require and to document that before a person is institutionalized in a

nursing home they MUST BE OFFERED home and community-based services.

Second, Congress will now permit States to set "more stringent

needs-based criteria" for nursing home placement than for home and

community-based service. This modifies the Medicaid Waiver provision that

required that a person had to be nursing home eligible before s/he could

receive community-based services. Now States can (IF they chose) reduce

their nursing home expenditures by offering community-based services to

persons whose ADLs are not at the nursing home level.

Third, Congress has mandated independent evaluations and assessments

for persons who request home and community based services to determine

what the person requires. These include face-to-face evaluations by

trained evaluators. In a truly IRONIC TWIST, Congress wanted independent

evaluations and assessments to prevent "unnecessary or inappropriate care"

in the community but has NEVER REQUIRED such for institutional care.

Disability advocates should ask your State Medicaid officials for the same

independent evaluations and assessments BEFORE persons are placed in

nursing homes. That will greatly increase EQUALITY and at the same time

prevent unnecessary institutionalization.

Fourth, as with Medicaid Waivers, States can limit the numbers of

persons who receive the home and community-based services and have

"waiting lists" to receive these services, which States may not have for

other State-plan services. While this is an unfortunate limitation, it

should make your State Medicaid officials more confident that costs will

be controlled, and we will be able to show the savings from preventing

unnecessary institutionalization. From disability advocates' point of

view, it's a start, and again like Waivers, "waiting lists" for community

services will be balanced against unnecessary expenditures in

institutions. Like Waivers, unfortunately States will not have to provide

home and community-based services on a "statewideness" basis nor the same

income and resource criteria applicable to other MA services. Thus, States

will be able to pick and limit who will receive these services and in what

part(s) of your State.

Fifth, persons in the community will be able to SELF-DIRECT their home

and community-based services. YAHOO!!!

Sixth, States can reduce their nursing home expenditures with "Money

Follows the Person" options for persons who have been in nursing homes for

at least six months. States can receive a significantly increased federal

match (more money than they receive for other State Plan services) to

provide home and community-based services so that persons can return to

the community with services instead of remaining unnecessarily

institutionalized in a nursing home. Your State must apply for this and

compete against other States.

DISABILITY ADVOCATES

The 2005 amendments regarding Home and Community-based services are

the result of your twelve years of organizing both locally and nationally

to end the institutional bias in both Medicaid and YOUR STATE Medicaid

programs. You MUST make sure that your Governor and your State Medicaid

officials take advantage of these amendments AS THE DISABILITY COMMUNITY

WANTS. You MUST take the initiative to make sure the changes are as you

want them.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at

http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

To contact Steve Gold directly, write to stevegoldada@cs.com

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at

http://www.stevegoldada.com

118

CASE STATUS REPORT
Current Cases

Bennett v. NYCHA (U.S.D.C. E.D.N.Y.)
NYLAG filed this case in 2002 as a class action challenging the New York City Housing Authority’s failure to provide reasonable accommodations to people with mobility impairments who have Section 8 vouchers.

If you are a section 8 applicant or a voucher holder and you have mobility impairment, the court case described above may help you get reasonable accommodations from the housing authority.

If you have questions or would like to get a copy, call 212-613-5001 or 212-577-3265

Milestone Victories

In 1990, Disability Advocates filed a class action lawsuit in the United States ... The complaint allege that NYCHA failed to provide the plaintiffs with Accessibility

Grist, Disabled in Action and the Greater New York Council of the Blind v. New York City Commission on Human Rights, (S.D.N.Y. 1997)

[For more information, contact John Gresham New York Lawyers for the Public Interest, Inc. E-mail – jgresham@nylpi.org ]

New York Lawyers for the Public Interest represents the plaintiffs in this case challenging the practice of the New York City Commission on Human Rights that denies equality of access to its written materials to people with visual impairments. The Commission sends copies of its written materials in standard print through the mail to anyone who asks without requiring any justification. When a man who has a visual impairment with a complaint pending before the commission asked for certain materials on tape, he was denied most of what he sought because the Commission felt he did not present enough of a justification. The complaint in federal court seeks a policy in compliance with the Americans with Disabilities Act, Section 504 of the Rehabilitation Act and the City Human Rights Law. Settlement was reached with New York City Commission on Human Rights agreeing to provide all materials in alternative formats in his own OMRDD residence. [Updated 7/2/01]

119

Emergency Case Filed Against Visiting Nurse Service for Abandoning Quadriplegic Woman

New York, New York – 20 June 2005 - Visiting Nurse Service of New York (VNS) illegally terminated home care services, without adequate notice, to a quadriplegic client, and made its actions even worse by defying an order by the New York State Office of Temporary and Disability Assistance (OTDA) to restore service pending a hearing. Representing the woman, the New York Legal Assistance Group (NYLAG) is today filing an emergency action, Llovet v. Doar, in the New York State Supreme Court to compel VNS to restore services to the woman.

The suit names VNS and the three government agencies which share responsibility to provide home care services to Medicaid recipients.

“VNS, OTDA, New York State Department of Health, and NYC Human Resources Administration (HRA) abandoned her without the continuous assistance she needs to survive,” said Jane Greengold Stevens, Director of Special Litigation at NYLAG.

In 1996, 26-year-old Aleydis Llovet was in a serious car accident that resulted in her becoming a quadriplegic. A Staten Island resident, Ms. Llovet is a C4/C5 quadriplegic, which means she can move her head and has some limited movement of her shoulders, but none in her wrists, hands, or any other part of her body. In the nine years since her accident she has lived at home for all but a few months, receiving 24-hour care in two 12-hour shifts from the Visiting Nurse Service, paid for by Medicaid.

However, in April 2005, VNS illegally terminated her services. They did not provide her with a required notice informing her of her right to appeal to the New York State Department of Temporary and Disability Assistance or that if she appealed in time she had a right to have services continue until a decision was reached on her appeal.

“VNS told me they were terminating my services because I was difficult to serve,” says Ms. Llovet. “It is true that I require extensive care, such as lifting, bathing, feeding, dressing, and helping with activities of daily living, but these are exactly the types of services that are necessary and to which I am entitled under Medicaid.”

“Despite VNS’ prominent advertising of these very services, they have refused to provide essential care to Ms. Llovet,” said Yisroel Schulman, Executive Director of NYLAG.

Ms. Llovet has survived the absence of VNS attendants only because a wide network of family and friends have generously devoted their time to care for her. Yet, the family is unable to sustain the level of care she needs for much longer. Ms. Llovet’s mother has been the major care-giver. However, she cannot continue lifting her 35-year old daughter. She is experiencing serious health problems of her own and her doctor has told her to stop.

Because of the threat to Ms. Llovet’s safety, the urgency of restoring her home care services is critical. Notwithstanding the generosity of her family, Ms. Llovet is left alone for long periods of time. Her quadriplegia causes her to have violent spasms during which she is in danger of falling out of her bed or wheelchair. After VNS terminated her services, she has already fallen out of bed once, and as a result had to go to the emergency room. When she fell, she was left helpless on the floor crying for help until she was discovered by her mother. She suffered bruises on her face, neck and arms and is still in pain.

Efforts by the New York Legal Assistance Group have resulted in getting an order from the New York State Office of Temporary and Disability Assistance that Ms. Llovet’s 24-hour care should be reinstated immediately, but VNS has refused to do so. On a temporary basis, another service provider is now caring for her for 8 hours a day, but that still leaves her helpless for 16 hours a day.

On Sunday, Ms. Llovet was admitted to Staten Island University Hospital after sustaining third degree burns to her hand because of negligent care by a new, untrained aid.

“VNS walked away from a woman who is entirely unable to perform any of the activities of daily living on her own,” said Ms. Stevens. “We hope a Court order will compel VNS to restore her 24-hour services immediately.”

Page

[1] [2] [3] [4] [5] [6] [7] [8] [9] [10]

[11] [12] [13] [14] [15] [16] [17] [18]

[19] [20] [21] [22] [23] [24] [25] [26]

[27] [28] [29] [30] [31]

News Page

Home Back to Top