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Inside Universal HealthCare Bill — p. 8
Volume 12, Number 1
Canadian Health Care — Page 9
SOURCES
January 10, 2001
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“Jazz to me is . . . pain swallowed in a smile..” — Langston Hughes
RESOURCES
January 10, 2001
AT THE CAPITOL IN 2001 Priorities For The New Session by Nathan Halvorson
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he 2001 Minnesota Legislative Session began on Jan. 3rd and will run through mid-May. This year, legislators will make decisions concerning health care, transportation, housing, education, human services, and welfare reform that could impact the community of people with disabilities. The following is a list of disability organizations and some of the issues important to them in this legislative session.
Minnesota State Capitol
Wound Clinic Closes by Nathan Halvorson
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he Minimally Invasive Care Center (MICC), which houses the Abbott Northwest Wound Clinic, closed its doors on December 31st. Ultimately, the reasons for the clinic’s closure were the very high cost of care and insufficient funds to meet those costs. Pat Hartwig, Vice President of Operations for the clinic— which has provided complete services to patients with complex, chronic and non-healing wounds such as diabetes and arterial injuries—cited several factors that led to the clinic’s financial challenges. First, the clinic never developed a consistent model of clinical care. She states, “we had eight physicians…practicing in eight different ways.” Also, clinicians had no database that could track, over a broad population of 450 people per month, a patient’s level of improvement. As a result of these inconsistencies, the clinic could not determine the best methodologies for treatment of a wound. Hartwig contends, “ we didn’t have any means of saying to a payer ‘Here’s why you should pay for the wound
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care because here’s what we’re seeing in the way of improvement.’” Another aspect of the clinic’s financial troubles involves extremely poor reimbursement rates from medical payers. As Ms. Hartwig indicates, “We have discounts with some of our payers such as Medicare in excess of 70 percent” meaning “we get less than 30 cents on the dollar for any charges we bill. So that leaves very little opportunity to even be able to cover costs.” She continues, adding “Within the years that the wound clinic has been in operation, the government compliance issues have changed around billing where Medicare patients are concerned, making it difficult for us to process claims on these patients. So even if we provided the care as cost-effectively as possible, we still have huge challenges as a hospital in being able to submit claims to Medicare.” A final issue that Hartwig brings up is the space used by the Wound Clinic. The Abbott Northwestern “hospital
setting…is an extremely expensive piece of real estate,” she insists. All of these factors combined—space, reimbursement from payers, and expenses due to inconsistencies in care and tracking models—have resulted in such a financial strain for the clinic that remaining open in its current form was no longer feasible, says Hartwig. Hartwig maintains that she struggled in making the decision. “It’s not our intent to make money on these patients. Our intent is to provide clinically high-quality care in a cost-effective model that is reimbursable by payers. It’s unfortunate. We don’t like closing programs here and we don’t do it frequently and we don’t do it easily. So we feel we’ve exhausted every opportunity we have with the clinic open to make change occur.” Both clinicians and patients of the Wound Clinic are equally upset by its closing. Jan Chevrette, a nurse with the wound clinic since it began seven years ago, predicts that patients will have diffiWound - cont. on p. 4
The Minnesota Consortium for Citizens with Disabilities (MNCCD) has established a broad-based coalition to help address the Medical Assistance (MA) Income Standard. The income standard is the amount of income seniors and persons with disabilities who need Medical Assistance are allowed to have if they are unable to work. CCD believes that this income standard “is grossly inadequate to pay even basic expenses and must be raised.” The coalition project, called the “100% Campaign,” proposes to raise the income standard to 100 percent of poverty, or $695/month, for a single adult, up from the current standard of $482/ month which is more than 30% below the poverty level. In addition, the Campaign is asking the legislature to raise the asset limits to equal the current state prescription drug program limits of $10,000 for a single adult and $18,000 for a married couple. This will provide uniformity between these state programs. The MNCCD Work Incentive Committee proposes to Allow MA-EPD participants to keep assets if they are unable to work.
Currently, people with disabilities enrolled in the Medical Assistance for Employed Persons with Disabilities (MA-EPD) program who become unemployed are forced to spend down their assets, including retirement savings, in order to remain MAeligible. The MNCCD Work Incentives Committee is concerned that a person could return to work for a couple years, develop a modest savings account and then see it evaporate within a couple of months if a health problem kept them off the job for longer than two months. The Committee proposes to freeze assets for a person enrolled in MA-EPD who is unable to continue working for a period of one year from the person’s last date of employment (for life, in the case of retirement benefits). Advocating Change Together (ACT) is continuing its campaign to urge the State of Minnesota to make a public apology to all persons with developmental disabilities who have been involuntarily committed to state institutions, and is seeking to have the State “commit itself in their memory to move steadfastly to ensure that all Minnesotans with developmental disabilities who in the future turn to the state for assistance will receive the appropriate assistance they need.” ARC Minnesota wants to give the consumer more control over the funding for their support services. Funding would allow an increase in consumer choices and options, a reduction in administrative costs of the system and an overall simplification of the complex service system.
ARC is seeking a legislative proposal to reform the public guardianship system for the 4,300 public wards in the state who have developmental disabilities, by shifting responsibility from the counties to a state agency or a multi-purpose non-profit organization. ARC will be promoting legislation aimed at addressing the shortage of personal care service workers, including increasing wages and expanding health insurance options for direct care staff. ARC is seeking increased federal funding to allow people to receive day training and habilitation services while living with their families. Also on the agenda is securing adequate funding to continue to provide entry cost assistance and home ownership counseling to persons with disabilities seeking to become homeowners. The Association of Residential Resources in Minnesota (ARRM) will provide steps in shifting control from government and providers to people with disabilities, removing constraints that prohibit more effective use of resources/ consumer control. ARRM also seeks to increase caregiver wages to the average personal income in Minnesota – $14.50/hr – in the next two years, and would like to develop tuition credit and career training programs, encouraging quality staff to build careers as caregivers. The Brain Injury Association of Minnesota will ask for funding for the Extended Employment Program (DES) to create a choice of supported-employment groups for people with brain injury. Also, the group wants state funding to replace federal
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