Fwd: Letter to Senator Rockefeller Re Dual Eligibles from IHSS Consumer Union.

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____________________________________ From: [email protected] To: [email protected] Sent: 1/14/2013 3:09:20 P.M. Pacific Standard Time Subj: Letter to Senator Rockefeller Re Dual Eligibles from IHSS Consumer Union. Attn Ahaviah Glaser: dear Ms. Glaser, I left a voicemail this evening for you and very much look forward to talking to you soon. Thank you and the Senator for your service and dedicated commitment to the well-being of Seniors and People Disabilities in the Dual Demonstration Pilots. -- Nancy Becker Kennedy The Honorable Senator Jay Rockefeller 531 Hart Senate Office Building Washington, DC 20510 (202) 224-6472 (202) 224-7665 Fax January 10, 2013 Dear Senator Rockefeller, you have been our champion! We get renewed hope from your letters to CMS about Dual Eligibles and your vigilance regarding our safety. Hearing you in the Senate Finance Committee hearing on the Internet about the Duals Demonstration Pilots gave us hope that governments will not be able to use it to cut the budgets and endanger us instead of coordinating our care. We are not in any way sure and have great reason to be concerned that managed care demonstration pilots will not be safe or effective in coordinating our care or containing costs, (see articles listed below.) We would not be opposed to pilots, to be proved that we are wrong. But as you yourself stated, using 70% and 80% of the state as a pilot project does less to test out the efficacy of a plan and instead seems more like fundamentally changing the entire mode of service delivery in the states. We are members of the In Home Supportive Services IHSS Consumers Union, a grassroots organization of Seniors and People with Disabilities, and CDR Californians for Disability Rights trying to keep our safety and civil rights under transitions to managed care. What may have started out to be a laudable project to coordinate the care of people who are eligible for both Medi-Cal and Medicare is being abused by the California Department of Health Care Services to cut the budget and is endangering very fragile people with complex conditions in the process of transitioning all people on Medi-Cal into managed care. We want to share the links pasted below to these news stories regarding the lawsuit protecting us in California, to inform you as you continue to be our champion! We are also attaching a List of Recommended Consumer Potections under Managed Care. Sincerely, Nancy Becker Kennedy, IHSS Consumers Union, Chair of the Managed Care Committee Of the Los Angeles County Public Authority, Southern California ADAPT Susan Kirk Chandler IHSS Consumers Union, President Californians for Disability Rights Joey Reilly, IHSS Consumers Union, IHSS Provider Michael Condon, IHSS Consumers Union, IHSS Consumer Ben Rockwell, IHSS Consumers Union, President, Board of Calif- ILC Independent Living Center, Californians for Disability Rights Lawrence Buchalter, IHSS Consumers Union Deborah Miles, IHSS Consumers Union, Executive Committee Of the Los Angeles County Personal Assistance Services Council Bertha Poole, IHSS Consumers Union, Member of Managed Care Committee of the Los Angeles County Personal Assistance Services Council Personal Assistant/Transition Specialist, Southern California Rehab Services, Blane Beckwith, IHSS Consumers Union, President Of Easy Does It Emergency Services, Berkeley California, Northern California ADAPT, Board Member Alameda Public Authority of California, CUIDO CUIDO, Communities United In Defense of Olmstead Ellyn Kearny, IHSS Consumers Union, Pastoral Counselor Ernie Castano, IHSS Consumers Union, Member of the Managed Care Committee, Personal Assistance Services Council of Los Angeles County Marvin Wasserman, IHSS Consumers Union Lillibeth Navarro, IHSS Consumers Union, Executive Director, CAL Life Independent Living Center, Chair, Los Angeles County Public Authority, ADAPT Marilyn Grunwald, IHSS Consumers Union, Disability Caucus California Democratic Party Randy Hicks, IHSS Consumers Union, Californians for Disability Rights, Legislative Committee Chair Bonnie Hagy, IHSS Consumers Union, Vice President, Postpolio Survivors Association Richard Daggett, IHSS Consumers Union, President, Postpolio Survivors Association , Patrick William Connally, IHSS Consumers Union Forest Harlan, Systems Change Coordinator, Independent Living Services of Northern California Alan Toy, Executive Director, Westside Center for Independent Living Raul Carranza, IHSS Consumers Union, _raulcarranza.org_ (http://raulcarranza.org/) Kathleen Riel, Program Manager, Independent Living Resource Center, Inc. of the Santa Barbara, Ventura and San Luis Obispo Counties Connie Arnold, IHSS Consumers Union, Californians for Disability Rights Charles Bean, IHSS Consumers Union Marta Russell, IHSS Consumers Union, Southern California ADAPT Hene Kelly -- Legislative Director CARA California Alliance for Retired Americans Doctor Bob Segalman CDR, Californians for Disability Rights, President Speech Communications Assistance By Telephone, Inc. Lynn Kersey, Executive DIrector, Maternal and Child Health Access Marvin Schachter, Commissioner, Los Angeles County Commission for Older Adults CUIDO, Communities United In Defense of Olmstead Michael Just, President AARP- Santa Barbara Kristine Choulakian, Masters Health Administration Kathleen Barajas, Californians for Disability Rights; Board Member, Ccommunities Actively Living Independent and Free; CALIF's System Watch Advocacy Team; IHSS Consumers Union Suzanne Janda, IHSS Consumers Union, CUIDO Communities United In Defense of Olmstead _Click here: Medi-Cal patients sue state over being forced into managed care | 89.3 KPCC_ (http://www.scpr.org/news/2012/12/21/35344/lawsuit-accuses-california-healthcare-officials-il/?utm_source=feedburner&utm_medium=feed&utm _campaign=Feed:+893KpccSouthernCaliforniaNews+(KPCC:+News)) _http://www.scpr.org/news/2012/12/21/35344/lawsuit-accuses-california-health care-officials-il/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3 A+893KpccSouthernCaliforniaNews+%28KPCC%3A+News%29_ (http://www.scpr.org/news/2012/12/21/35344/lawsuit-accuses-california-healthcare-officials-il/?utm_s ource=feedburner&utm_medium=feed&utm_campaign=Feed:+893KpccSouthernCaliforni aNews+(KPCC:+News)) _http://www.lafla.org/newsletter.php?utm_content=ecastano%40aol.com&utm_sour ce=VerticalResponse&utm_medium=Email&utm_term=area&utm_campaign=The+Will+to+ Persevere%3A+LAFLA+Matters+Nov%2FDec+2012#first_ (http://www.lafla.org/[email protected]&utm_source=VerticalResponse&utm_mediu m=Email&utm_term=area&utm_campaign=The+Will+to+Persevere:+LAFLA+Matters+Nov/ Dec+2012#first) _http://articles.latimes.com/2012/dec/23/local/la-me-medical-lawsuit-2012122 3_ (http://articles.latimes.com/2012/dec/23/local/la-me-medical-lawsuit-20121223) Lawsuit Challenges Mandated Transfer to Medi-Cal Managed Care for Seniors and Persons With Disabilities Who Suffer From Complex Medical Conditions On December 21st, LAFLA, the Western Center on Law & Poverty and National Health Law Program filed a lawsuit against the California Department of Health Care Services (DHCS) and its director, Toby Douglas, on behalf of Della Saavedra, Juan Cameros, Anita Valadez, Raquel Alvarez and Azatui Charkhchyan (Petitioners), who were harmed by the state’s failure to protect their right to continue their care with doctors and specialists they had been seeing before being forced to join a health plan against their will. Until recently, these Medi-Cal beneficiaries were able to obtain necessary specialty care in an ongoing and coordinated manner from physicians who treated them on a fee-for-service basis. At stake in this lawsuit is the health and safety of Petitioners and thousands of other low-income California Seniors and Persons with Disabilities, who suffer from complex, often life-threatening, medical conditions, who are eligible and should be exempted from involuntary enrollment in Medi-Cal managed care plans so their critical care is not abruptly disrupted," states Elena Ackel, senior attorney, Legal Aid Foundation of Los Angeles. Beginning in June 2011, more than 240,000 seniors and persons with disabilities in Los Angeles and 15 other California counties received notices that they would be transferred to a Medi-Cal Managed Care Plan. These beneficiaries receive Medi-Cal but not Medicare. Approximately 27,000 of these disabled beneficiaries filed exemption requests indicating they had complex medical conditions which allowed them to remain in fee-for-service Medi-Cal. Under state law and regulations, Medi-Cal beneficiaries are entitled to remain with their fee-for-service providers if they are currently receiving treatment for a number of specifically enumerated complex medical conditions or qualify under a catch-all category. For example, there is a specific exemption for cancer patients if they are undergoing a course of treatment or if they have been approved for a course of treatment. Petitioner Della Saavedra requires treatment for her Multiple Myeloma (a type of cancer), hypertension and diabetes and thus was entitled to be exempt from managed care. Nevertheless her claim for exemption was denied because the state was applying a secret and more stringent standard than allowed by law when reviewing exemption requests. Further, the beneficiary and his or her doctor had no notice of these unwritten standards that were being applied in reviewing of exemption claims. As a consequence, many of the beneficiaries who meet the exemption standards have been wrongfully transferred to managed care and cannot get the specialty care and medications that they need. Robert Newman, Senior Counsel at the Western Center on Law and Poverty, asserts, "The Department of Health Care Services treats many of these frail, elderly and disabled individuals with complicated medical conditions as though they have run-of-the- mill problems. A person who is receiving treatment for cancer or kidney failure cannot suddenly be cut off from their regular treating physicians and told to find new doctors to treat them." This lawsuit seeks an order from the court prohibiting DHCS from continuing their unlawful practices, and allowing Petitioners and others like them who have been wrongfully denied an exemption to resume getting critical health care with their previous fee-for-service Medi-Cal providers until those doctors indicate it is safe for them to be transferred to a managed care plan. Nancy Becker Kennedy Join the IHSS Consumers Union on Facebook at http://www.facebook.com/groups/IHSS.ConsumersUnion/ “Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has.” -Margaret Mead