MINUTES FOR CNSW NY METROPOLITAN CHAPTER – MARCH 16, 2016
EXECUTIVE COMMITTEE MEETING: Our June CNSW meeting has been changed to June 22, 2016 instead of June 15, 2016 due to room constraints. Our October meeting remains Oct. 19, 2016.
We will be having some changes on the executive committee effective in October, 2016. Amylynn Karnbach will finish her term as President and Nicole Harrison will be the new President. Ariella Tomback will be our new Vice President. Joanne Courtade is retiring as sponsorship person and Mary McKinney will be retiring as Secretary. Maria Argentina will become Secretary and Joani Panitz will become the new sponsorship person and she also remain as our Queens Borough Rep. Dana Weinreb will become the Membership Person and also our new Web Master. Mary Rzeszut has stepped down as Legislative Rep. and Amylynn Karnbach agreed to fill the Legislative Rep. position. New borough reps: NYC, Jeanette Alexander, Brooklyn, Theresa Esposito.
In reviewing the Rules and Regulations of CNSW, retired people can still be members of CNSW but retired people can’t be named to any positions on the Executive Committee.
ACCESSING INSURANCE FOR UNDOCUMENTED IMMIGRANTS presented by Sarika Saxena, Staff Attorney, Health Justice Program, NY Lawyers for the Public Interest.
New York Lawyers for the Public Interest is a nonprofit organization that uses community lawyering model to serve low income New Yorkers of color. The Health Justice Program promotes immigrant and language access to healthcare.
Approximately 250,000 New Yorkers are undocumented and uninsured. They have limited access to healthcare and they rely on emergency care and Emergency Medicaid. There is full Medicaid eligibility for PRUCOL immigrants in NYS. The following are various immigration statuses: US Citizen, Lawful Permanent Resident (LPR/Green Card Holder), Non- immigrant (Temporary Visa) and Undocumented (Visa overstay, entered without inspection – EWI).
Classifications for benefits laws: Qualified aliens, lawfully present and PRUCOL (Permanently residing under the color of law). PRUCOL refers to applicants for immigration benefit who do not have employment authorization document (EAD), applicants for and individuals with deferred action for childhood arrivals (DACA) and deferred action based on individual circumstance.
Health care options: Qualified Aliens – Medicaid, Essential Plan, Child Health Plus. Lawfully present: Qualified Health Plan, EP, CHP. PRUCOLl only: Medicaid. Undocumented immigrants, not PRUCOL eligible: Emergency Medicaid, HHC Hospitals/Options, Charity Care, community Health Centers. Undocumented and under age 19: CHP, If pregnant, Medicaid for Pregnant Women.
Overview of process: Patient calls NYLPI (212-244-4664) and has a phone screening. NYLPI provides immigrant representation. Once client is PRUCOL, NYLPI will refer to a navigator to enroll in Medicaid. Medicaid equals better access to healthcare.
A great lunch and presentation of their transportation services provided by Ambu-Trans Ambulette Services – contact Neal Kalish (Tele: 914-699-0785, cell: 914-906-0654, Email: NXKNYC@gmail.com) for any questions.
Page 2 – Minutes CNSW Meeting March 16, 2016.
PARTNERING TO IMPROVE PATIENT ACCESS TO CARE, REDUCING “FAILURE TO PLACE” presented by Evan Smith, LMSW, MBA, Patient Services Director, IPRO/ESRD Network of NY.
Involuntary discharge is a situation in which a patient is informed in writing that treatment at a dialysis facility will terminate in 30 days or the dialysis facility notifies the Network of an abbreviated termination procedure for a patient who has made an immediate severe threat.
Failure to Place is a situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment; an involuntary discharge may, but does not necessarily, lead to a failure to place.
The Conditions of Coverage limit involuntary discharges or transfers to the circumstances outlined at 42 C.F.R. (listed at V766 and V767. These are: lack of reimbursement, facility ceases to operate, facility can no longer meet the patient’s medical needs, ongoing disruptive behavior, immediate severe threat and physician termination.
C of C for coverage for ESRD Facilities – 494-180 Governance. Facility documents the reassessments, ongoing problems, and efforts made to resolve the problems and enters this documentation into the patient’s medical record. Provides the patient and the local ESRD Network or state survey agency with a 30-day notice of the planned discharge. Obtains a written physician’s order that must be signed by both the Medical Director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility. Contacts another facility, attempts to place the patient there and documents that effort. Notifies the state survey agency of the involuntary transfer or discharge.
Involuntary Discharge End Result: Failure to Place. From 2013 to 2014, failure to place cases grew by 60% in New York State. The only option for a “failure to place” patient is to receive dialysis treatment through a hospital emergency room. Failure to place creates issues related to continuity of care for the patient and places a strain on hospital resources.
In July 2015, IPRO/ESRD Network of NY in collaboration with CMS and the NY State Department of Health developed a pilot program aimed at: reducing the risk that a dialysis unit assumes when they accept a known “failure to place” patient. Ensuring that these patients receive an elevated level of support to help them adjust to the outpatient setting.
Dialysis units are offered an option to admit a “failure to place” patient for treatment on a 30-day trial period. Elevated support is provided, IDT meeting prior to first treatment and weekly follow by facility and network.
If the patient adapts positively to the new dialysis unit after 30 days, he or she will be permanently accepted to the unit. If there are behavioral issues, the unit does not have to continue treatment within the trial period. For further information, IPRO/ESRD Network (Phone 5216-209-5578, toll free 800-238-3773 Patients and Email info@nw2.esrd.net.
Page 3 – CNSW Minutes, March 16, 2016.
USE OF THERAPY DOGS IN AN IN-CENTER HEMODIALYSIS CLINIC presented by Camille Coiro, LCSW, Yorktown Artificial Kidney Center.
It is very important to set up policy and procedures when initiating a therapy dog program in a dialysis clinic. You need to receive corporate compliance, need support from administration and staff and work with a group such as Therapy Dogs International. SW conducted an early survey of staff and random patients. Our policy needed to include guidelines for staff, patients, dogs and handers. Needed DOH guidelines – the local hospital provided their policy and procedures. All patients must give consent. Those participating patients must have their physician consent.
Stated purpose of dog therapy in policy and procedures included: personalized patient care, enhance the quality of the dialysis experience, reduce stress and anxiety, ease transition to dialysis, benefits to staff, benefits to family member also. Must be mindful of HIPPA regulations, the time restraints of the clinic schedule/turnover, infection control.
Needed to work with the dog handlers as they had little experience with dialysis, appropriate dress was necessary so paper lab coats used. Only Therapy Dogs International dogs were used – no patient or staff dogs. Dogs must wear bandanas, dogs must be well groomed, have clean paws, had provisions for accidental soiling, dogs must be supervised and leashed.
Other considerations included: allergies, open wounds, fear of animals. Unexpected challenges we faced: awkward seating including blood pressures lines, access, staff bringing in patients early, early hours for SW, participation not as high as hoped, how to evaluate program. One must be committed to the program.
A great and informative program.
Respectfully submitted,
Mary McKinney, LCSW
CNSW Metro NY Chapter 