Brain Injury Lawyer - New York

New York State Mental Retardation and Developmental Disability New Information Line-Complaint Line and Web Site

The New York State Office of Mental Retardation and Developmental Disabilities (OMRDD) has established a new information and complaint line as well as a new web site.

The information line is designed to help people get answers to questions about supports and services for individuals with developmental disabilities in New York State.  It is also sued to take complains of alleged misconduct, fraud, waste and abuse in the service system. 

The toll free information line offers assistance in English, Spanish and most other languages.  A significant amount of useful information is also available at their web site.

The telephone number is 1-866- 946- 9733; TTY 1-866-933-4889.  You can also go to the Office of Mental Retardation and Developmental Disability web site. 

Nursing Home Rating Scale

The quality of care rendered in nursing homes has always been of interest to me.  In addition to representing victims of traumatic brain injury, De Caro & Kaplen, LLPalso represents victims of nursing home abuse including patient’s who have sustained decubitus ulcers (bed sores), falls and brutality in nursing homes.

 

While it is important for families to always visit a nursing home before their loved one is admitted and to continue to monitor care once an admission takes place, some further information can now be obtained from a new system that rates nursing home care across the country.

 

A five star rating system has been established by the Centers for Medicare & Medicaid Services.  This federal agency oversees the quality of care in the nation's nursing homes. You can access the nursing home ratings by clicking the highlighted text.

 

Hopefully this new information will benefit the public and cause nursing homes that fall below acceptable levels of care to provide more appropriate care to their residents.

Survey of State Medicaid Waiver Programs

Traumatic brain injury waiver programs that will enable those suffering from brain damage to receive services in a home or community based setting vary greatly from state to state.

MedThe Center for State Health Policy, the Institute for Health, Health Care Policy and Aging Research, Rutgers University has recently published an issue brief, “A Survey of Medicaid Brain Injury Programs” by Leslie Hendrickson, Visiting Professor at Rutgers Center for State Health Policy, and Randall M. Blume of Blume Associates, LLC.

The 116-page paper addresses waivers targeted to individuals with a brain injury.  States that had such waivers were identified and contacted to obtain information about how the state decided to create a waiver program, what the eligibility requirements were to obtain services, what the services were, and other information.

In late 2007, the Center for State Health Policy surveyed 23 states that operate brain injury waivers.  Data was obtained about the cost and number of individuals served by these waivers for the waiver years 2002 through 2006.  Three states began waivers for individuals with brain injuries in
2002 or later, and three other states discontinued waivers in 2006.  Every state except Arizona has multiple Medicaid 1915(c) home and community-based services (HCBS) waivers.  Arizona operates its long-term care system as an
1115 Waiver.

Services provided under the brain injury waivers vary considerably from a single waiver service to extensive arrays of services.  The size of the waivers also varies from 19 individuals to over 3,600 individuals served in a year.

You can read about: traumatic brain injury waiver services

Medicaid Assistance following a brain injury

One of the most important resources for persons with a brain injury are the health and rehabilitation benefits provided by Medicaid. New York has been the leader in establishing home based care for victims of brain injury through its Medicaid waiver program.  This program will fund services in the community which in the past would only be funded if provided in a nursing home setting. 

The Medicaid  benefits are "needs based" meaning that in order to qualify, your income must be below certain set levels.  These low income levels has made it very difficult for many individual to receive needed assistance.

Medicaid has now raised the Resource Level to $13,050 for a single individual and to $19,200 for a couple on Medicaid.  The increase of the Medicaid resource allowance from $4,350 to $13,050 for a single individual (and from $6,400 to $19,200 for a couple) may make it easier for some individuals and couples to qualify for Medicaid, and to access Medicaid nursing home and home care services including the traumatic brain injury home based waiver program in New York State.

You can obtain more information on the New York State Medicaid Traumatic Brain Injury Waiver program by going to the Brain Injury Waiver web page

Brain Injury Association of America Condemns President's Budget Requests

The Brain Injury Association of America has requested that I circulate the following press release concerning the proposed elimination of the Federal Traumatic Brain Injury (TBI) Program in President Bush's budget submission to Congress:

Brain Injury Association of America Condemns President’s Fiscal 2009 Budget

(Washington, D.C.) – For the third year in a row, The White House has proposed the complete elimination of the Health Resources and Services Administration (HRSA) Federal TBI Program, which provides grants to state agencies and protection and advocacy organizations to improve access to health and other services for individuals with traumatic brain injury (TBI) and their families. 

Increasingly, national policymakers and the American public are coming to understand the dramatic implications of TBI on active duty service members, veterans and civilians alike.  In his State of the Union speech last week, President Bush pledged his dedication to meeting the health care needs “of a new war and a new generation.”

“As more service members and veterans join the 1.4 million civilian children and adults who sustain TBIs in the U.S. each year, the lack of priority given to TBI in the President’s budget is deeply disappointing,” said Susan Connors, president and CEO of the Brain Injury Association of America (BIAA), adding, “President Bush just doesn’t get it.”

“My family’s experience demonstrates the interdependence of military and civilian systems of care,” said Dave Woodruff, a member of the BIAA Board of Directors whose brother, ABC anchor Bob Woodruff suffered a severe TBI while covering the war in Iraq.  The Federal TBI Program supports coordination among state government agencies and public and private organizations to improve TBI care from trauma to community re-integration.  Most military and civilian patients end up living in the community where a complex maze of service systems, if it exists, must be coordinated.

BIAA will work vigorously to restore funding for HRSA's TBI Program, joining with coalition partners at the national level and calling on the highly effective Congressional Brain Injury Task Force to educate their colleagues in Congress and The White House on the need for and value of the Federal TBI Program.

Virginia Faulted on Care to Brain Injured

A report issued by a Virginia legislative review commission concluded that tens of thousands of people in Virginia with traumatic-brain injuries lack adequate residential facilities, access to therapy, transportation or occupational help. 

Further jeopardizing the already taxed system of brain injury care in Virginia is the prospect of returning veterans with brain damage who will also require care with no plans on how to deal with this growing epidemic. 

Unfortunately, Virginia is not the only State that lacks the proper resources to adequately care for the thousands of individuals who must live with a traumatic brain injury on a daily basis. Most states do not maintain proper statistics on the number of individuals who sustain brain injury in a give year and lack proper support services for brain damaged individuals and their families.  Rehabilitative services in many places are fragmented and not easily accessible.  Most states have improper levels of funding to support brain injury services and most individuals do not receive the services they deserve.

In Virginia, most if not all facilities will not accept Medicaid to pay for residential care.  In fact, the only facility in the state that does accept Medicaid payments for residential care for traumatic brain injury victims will stop accepting these patients later this month.

But, Medicaid funding is not the only issue.  Issues of private insurance and why these health insurers are not paying for brain injury rehabilitation services needs to be addressed.

You can read more about this 130 page report by clicking here.

Unmet Needs of Brain Damage Victims

I was recently appointed as Chairperson of a new committee formed by the New York State Traumatic Brain Injury Services Coordinating Council to examine the obstacles that persons with a brain injury are having in New York State to obtaining needed treatment.

In the last several years  the council has devoted a great deal of attention to services provided through the Medicaid, Traumatic Brain Injury waiver program.  The council realizes that there are many individuals who have sustained brain damage that are not eligible for the waiver and have needs that may not be fully met by the current health care delivery system.  Consequently, this new committee within the council was formed which I was selected to chair.

The council has approved the following letter which has been posted by the New York State Health Department on its health provider network to obtain information that will be helpful in examining this important area.  I ask you to please respond with relevant information.

"Dear Provider, Individual(s) with TBI and Other Interested Parties:

The Traumatic Brain Injury Services Coordinating Council (TBISCC) was formed by act of the New York State Legislature to advise the Department of Health regarding service needs of persons who have sustained a traumatic brain injury.

The TBISCC has examined a number of issues relating to availability and quality of services for individuals with a brain injury.  Recently, the TBISCC has turned its attention to the unmet needs of those who have sustained a traumatic brain injury, particularly to the obstacles to obtaining treatment and assistance through third party payers, such as:

• Benefit Limitations (i.e. they wouldn't pay beyond a certain number of days)
• Medical Necessity (i.e. they didn't think the services were necessary)
• Coverage Limits (i.e. the services needed were not covered)
• Reimbursement Limits (i.e. the plan reimbursement was inadequate to fund the services required)

Third party providers include Worker's Compensation, no fault insurance, health insurance, managed care plans or other insurance plans that provide benefits for medical care and rehabilitation following a brain injury.

We have enclosed a questionnaire which we ask you to complete and return to us concerning problems you may have encountered with third party payers in obtaining brain injury related services.  In addition, we also would welcome your suggestions for improving the delivery of services to persons who have sustained a traumatic brain injury where funds are provided by third party payers.  Please feel free to share the questionnaire with anyone you know who would also like to prove us with input on these issues."

Please return your questionnaire and other information to the Council by written communication at

Traumatic Brain Injury Services Coordinating Council
New York state Department of Health
161 Delaware Avenue
Albany, NY 12054
Attention: Dawn Crary

[You can a questionnaire by requesting one from Dawn Crary or forward your narrative experience directly to her.]

Very truly yours,

Michael V. Kaplen, Esq.
TBISCC Unmet Needs Subcommittee Chairperson
Charles Wolf, TBISCC Chairperson
Judith Avner, Esq. TBISCC, Vice Chairperson

 

Consumer Guide Available to Assist People with Disabilities in Navigating Medicare Part D Coverage

Advancing Independence, a disability-focused policy organization, released today a new guide, Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare: A Guide for People with Disabilities, Benefits Counselors, Disability Organizations and Others On Transitioning to the Medicare Part D Prescription Drug Benefit.

While many organizations are developing helpful materials to assist Medicare beneficiaries through this transition, this guide was written specifically to address special concerns of people with disabilities. The guide was written in a question and answer format and includes worksheets that individuals can use in consulting their physicians about current pharmaceutical use and
in comparing and selecting a plan that meets their needs.

Medicare plays a critical role in enhancing the health and independence of nearly 15 million people with disabilities of all ages most of whom rely extensively on prescription medications.
It is essential that they be able to make the best use of the new Medicare prescription drug benefit, said Bob Williams, Principal of Advancing Independence and a co-author of the report.

The report was a collaborative effort between Advancing Independence and the Health Policy Institute at Georgetown University. Free copies of the guide can be obtained in PDF and
HTML formats at http://hpi.georgetown.edu/rxchanges.html.

New York State Traumatic Brain Injury Program Loses Valuable Asset

I was saddened to learn today that the Ronnie Gala has retired from her position as the Bronx and Queens Coordinator for the New York State Traumatic Brain Injury Medicaid Waiver Program.

Ronnie has been the Regional Resource Service Coordinator (RRDS) for the Traumatic Brain Injury Waiver Program since the program's inception in 1994.  Much of the programs success and its ability to repatriate persons with traumatic brain injury from out of state institutions to home based community TBI programs is due to the hard work and persistence of Ronnie.  She has made the quality of life better for persons with mild, moderate and severe brain injury.  Her devotion to victims of coma had led to the development of special coma recovery units in New York and specialized TBI care facilities.  I have had the pleasure of working directly with Ronnie both on behalf of clients that I have represented as well as others who just needed some guidance and assistance.  Ronnie always was able to assist. 

In the course of her career with the Health Department Program she has made an important difference in the lives of persons suffering from traumatic brain injury and their families, not only in the Bronx and Queens, but throughout the City of New York and the State of New York. As the RRDS for Bronx and Queens, she repatriated 90 individuals from out of state nursing homes--the largest number of repatriations of any single RRDS. As Dorothy, in The Wizard of Oz has so wisely stated, "THERE'S NO PLACE, LIKE HOME".

The work and devotion of Ronnie Gala will certainly be missed by all who know her and have benefited from her caring approach to the mission of the New York State Medicaid Waiver Program. (For those not familiar with this program, it allows for medicaid funds and services to be provided to persons who have sustained a traumatic brain injury within the home and community rather then a requirement that they must be institutionalized in facilities such as long term care facilities, nursing homes or brain injury rehabilitation facilities in order to eligible for services. See end of this post for contact information concerning this program)

I am hopeful that Ronnie will continue to work with the Brain Injury Association of New York State, to improve the quality of life for persons with brain injury, their family and friends.

Fondly,

MICHAEL V. KAPLEN, ESQ.
President, Brain Injury Association New York State

[More information on the New York State Traumatic Brain Injury Medicaid Waiver Program can be obtained by contacting the Program Coordinator, Pat Ryan Greene Gumson at the New York State Department of Health, Bureau of Long Term Care Brain Injury Program, Office of Medicaid Management, One Commerce Plaza, Rm 803, Albany, New York 12260  518 474 6580 and by e mailing Pat Gumson.]

Hurricaine Katrina More Disability Information

For case managers, disability attorneys, families and friends concerned with persons with a disability including persons suffering from disability caused by a traumatic brain injury who may have been affected by Hurricane Katrina the following is further information obtained:

Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities

The following information is intended to provide the disability community with information about the federal governments efforts to work with them during this crisis.  Much information is flowing to us; this bulletin is an effort to get some responses back.

Interagency Coordinating Council Forms an Incident Management Team. This Team consists of representatives from several federal agencies. Our goal is to provide an organized and coordinated way to respond to the issues that are being directed to the Council at an overwhelming rate.  This
Team will facilitate timely resolution of these issues, coordinate responses, as well as coordinate with other similar recovery efforts underway at the federal, state and local levels. 

How to Contact the Incident Management Team:  If you want to raise an issue to us, please send an email to: disability.preparedness@dhs.gov.
Someone will be checking that email account regularly, all through the weekends. 

When we receive an issue or concern, we will try to boil it down into a concrete, specific action item.  We will try to prioritize it according to whether it is short-term and urgent need, is focused on the medium-term, or is focused on the long-term.  We will try several avenues for dealing with it, including: Send it to our wonderful contact in FEMA management Send it to one of the federal agencies on the ICC, if that agency is able to resolve the matter Send it to one of several officials within DHS headquarters who have offered to help us solve problems Send it to one of our friends in the disability advocacy community, if the request might be addressed in the private sector rather
than the public sector.   

Please remember that the governments response to this crisis is multi-layered  dont forget to reach out to state officials and local officials on the ground.  Also, do not hesitate to contact others in the
federal government who you think might be helpful (for example, NCD has been very active and effective; they are looped into the ICC, but also have independent avenues for getting things done).  Do not hesitate to pursue multiple options for getting your issue heard and resolved!


FCC Issues Public Notice Reminding Video Program Distributors of the Need to Make Emergency Information Regarding Hurricane Katrina Evacuation and Relief Effort Accessible to Persons with Hearing and Vision Disabilities.

The FCC issued this critical Notice today amid complaints that emergency information being provided over television is not being made accessible to individuals who are deaf or hard of hearing.  The Commission has also received complaints that emergency information that was provided visually was blocked by other information on the screen or that emergency information provided visually blocked closed captioning.  Go to
http://hraunfoss.fcc.gov/edocs_public/attachmatch/DA-05-2438A1.doc to access this Public Notice online.