Involuntary treatment proposal divides doctors and patients

The Department of Mental Health took public input for 90 minutes Tuesday on a proposal that would dramatically change the way people behaving psychotically are forced to have medical treatment in Vermont.

Frank Reed, the commissioner of the department, and his team met in the newly rebuilt Waterbury State Office Complex with about 20 proponents and opponents of a change to due process for psychiatric patients.  ...

“We shouldn’t be here,” said Jack McCullough, the director of the mental health project at Vermont Legal Aid. McCullough said his office represents the vast majority of mental health patients during these involuntary proceedings.

McCullough opposes limiting the number of independent psychiatric evaluations. He said patients need two; the proposed changes would limit evaluations to one, provided it doesn’t delay the initial hearing. If the law is changed, McCullough said there would not be enough time for patients to get even one prior to the hearing.

Lawmakers learn Vermont Health Connect biller was sold

The third-party biller for Vermont Health Connect was sold to a publicly traded company three months ago and no longer goes by the name Benaissance.

Several lawmakers in the House of Representatives and the lobbyist for Blue Cross Blue Shield of Vermont say they didn’t learn of the transaction until Wednesday during testimony that questioned the company’s refund policies.

Trinka Kerr, the chief health care advocate for Vermont Legal Aid, was the first witness to reveal the sale. She told lawmakers about it in the context of two Vermont Health Connect customers who she said are still waiting for account refunds.

Kerr said the two customers are seeking refunds on their health insurance policies. She said Vermont Health Connect told them the only way to get those refunds is to terminate their existing policies and re-enroll. Neither wanted to re-enroll because enrollment was so difficult in the first place, she said.

Panel looks to ditch involuntary medication plan from budget

Gov. Peter Shumlin wants to save $5 million by expediting the court process for involuntary medication of mental health patients. But that proposal is meeting resistance from key House lawmakers.

[Frank Reed, the commissioner of the Department of Mental Health, said] that the department had not had time to vet the proposal with members of the judicial branch, Vermont Legal Aid and other entities that would be affected. 

The following was included in a memo to the Vermont House that was posted in a lengthy comment on this article: 

The number of applications for such involuntary medication has more than doubled in that time frame. See a recent Vermont Legal Aid (VLA) newsletter:

Although the Legislature concluded in 1998 that “It is the policy of the General Assembly to work toward a mental health system that does not require coercion or the use of involuntary medication,” the Department of Mental Health has filed increasing numbers of involuntary medication cases every year since 2008.

VLA’s Mental Health Law Project records show that the Department filed 80 involuntary medication cases in 2015, breaking the previous record of 77 filed in 2014. The number of involuntary medication cases filed by the State has more than tripled since 2008 and more than doubled since 2011, the year the State Hospital closed.

New Analysis Looks at Causes Of Vermont Health Exchange Woes

Witnesses from two insurers and Vermont Legal Aid all started their remarks to legislators Wednesday by saying positive things about Vermont’s embattled health insurance exchange and the people who run it, but the issues they’re having dominated the meeting. The House Health Care Committee was holding its second hearing to determine whether the state should abandon Vermont Health Connect and move to the federal exchange. ....

Vermont Legal Aid said it’s helpful to have the automated function working again for people who sought to make changes at the beginning of 2016, but the changes for 2015 still need to be worked out.

“The state still can’t process 2015 change of circumstances, so we’re still getting calls and working on cases that haven’t been resolved for 2015 changes,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “And one of the consequences of that is that people are starting to get their tax forms now, the 1095-As, and they will be wrong if their change of circumstance wasn’t properly recorded,” she said.

“We already talk to the Vermont Health Connect staff once a week ... and now we’ve scheduled an additional meeting trying to address tax-related issues,” Kerr said.

Vermont Legal Aid

Kerr testified for the second time in two weeks about customer experiences. She said a woman called her office in tears Tuesday because she was erroneously dropped from her commercial insurance on Vermont Health Connect.

“I think she tried to get some medication and was told that she didn’t have coverage,” Kerr told the committee. “She was saying that she was going onto anxiety medication because it was so stressful.”

The room fell silent when lawmakers heard Kerr tell the story. Lippert closed his eyes and paused for a moment before asking her further questions.

“We’re still seeing a lot of problems,” said Kerr. “We’re still getting slammed with calls. I’ve looked around for some good things to tell you, and there are a few good things.”

She said that even though the number of customer calls to her office increased at the end of 2015, fewer people called last month than in January 2014. But she said her staff is still frustrated “by what they describe as returning cases.”

“The bad things are we’re still getting a lot of calls, and they’re really complicated,” Kerr said. “That’s really frustrating to people, too — the fact that their changes from last year haven’t been resolved.”

Vt. Health Site Still Has Backlog

Gov. Peter Shumlin’s health care reform team told the House Health Care Committee on Thursday about bigger challenges with Vermont Health Connect than was previously reported.

Lawrence Miller, the chief of health care reform, said the number of changes to customer accounts waiting to be handled by the state’s health insurance exchange peaked at 5,700 on Jan. 25. The number is higher than the 4,000 that VtDigger reported Jan. 24 from Blue Cross Blue Shield of Vermont and the 3,000 that Vermont Public Radio reported a few days earlier. In a Jan. 21 interview, Miller was unable to give VtDigger a number of backlogged cases.

Blue Cross Blue Shield of Vermont and Vermont Legal Aid have both requested that the state commission an independent review of Vermont Health Connect to determine whether there are problems with the technical structure of the exchange. Miller said Jan. 21 that an independent review is not necessary, and he has declined to give further interviews.

Tax Scams Are Targeting Uninsured, I.R.S. Warns
The Internal Revenue Service is warning consumers about tax scams involving the Affordable Care Act and penalties imposed under the law on people who go without health insurance. In some cases, the agency said, unscrupulous tax preparers tell clients to pay the penalties directly to them, and they keep the money.

Christine Speidel, a tax lawyer at Vermont Legal Aid, welcomed the government’s effort to warn consumers, including undocumented workers in particular. “This population is very vulnerable to exploitation by tax preparers,” she said.

... In the absence of national standards, [Nina Olson, national taxpayer advocate at the IRS] said, “a person can hold himself out as a return preparer with almost no knowledge or skill by simply sitting with a taxpayer and working through” the questions in tax preparation software.

... President Obama has proposed giving the I.R.S. more authority to regulate tax preparers. But Republicans, still angry with the agency over what they see as its improper scrutiny of Tea Party groups, have been reluctant to give it additional authority at this time.

Join Us in Brattleboro to Talk about Discipline in Schools

Do you agree with a report that says that students of color or with disabilities are expelled or suspended more often than other students? Join us to talk about that and more.

When: Thursday, February 4, 2016, 6:00 p.m.

Where: Brattleboro Boys and Girls Club, 17 Flat Street, Brattleboro, VT


Mel Motel, Just Schools Project Jay Diaz, ACLU and lead author of the Vermont Legal Aid report Kicked Out! Unfair and Unequal Student Discipline in Vermont Public Schools The Honorable Katherine Hayes, VT Superior Court Judge Mary Ross, Assistant Principle, Academy High School Mike Szostak, Restorative Justice, Brattleboro Union High School

The event is sponsored by Vermont Legal Aid, the Just Schools Project and the Windham Southeast Supervisory Union Office of Diversity, Equity and Social Justice.

To find out more, email Vermont Legal Aid attorney Jean Murray –

Hearings to explore problems, future of health exchange

The House Health Care Committee will begin weekly meetings on the future of Vermont Health Connect by hearing Thursday from Lawrence Miller, the Shumlin administration’s chief of health care reform.

Committee Chairman Bill Lippert, D-Hinesburg, said Miller will address the panel at 4:30 p.m. Thursday.

... last week lawmakers said they felt blindsided because many heard about the backlog for the first time in the news media. Blue Cross Blue Shield of Vermont and Vermont Legal Aid are both calling for an independent review of the exchange’s technical foundation.

... At the end of the hearings, Smith said, he will talk with Lippert to find out whether the state should abandon the Vermont exchange. “The different options have their own challenges, and we’ve always known that, and that’s one of the reasons we’ve been willing to stick with the state exchange,” Smith said.

Vermont Health Connect is going backward, stakeholders say
Lawmakers who play watchdog, insurance companies that rely on the system to sell plans to individuals, and health care advocates who take calls from customers are all concerned about the status of Vermont Health Connect.

“We’re going backwards,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “Towards the end of last year, we were making progress. You could get things straightened out relatively quickly, and now things are more complicated than they used to be.”

Kerr shared data with lawmakers showing that calls regarding change of circumstance issues — from customers trying to make insurance changes because of a life event such as divorce or the birth of a child — hit a one-year low in October and then steadily went up in November and December. She said the situation is “depressing” and, among her staff, there’s “a fair amount of burnout happening.”

“There’s no doubt that sometimes people aren’t getting care as a result of this (health exchange),” Kerr said. “It’s definitely affecting their anxiety level about it.” She has now joined Blue Cross Blue Shield of Vermont in asking for an independent review of Vermont Health Connect.

Advocates: Other savings justify restoring Reach Up benefits

Advocates are again pressing legislators to repeal a $125-a-month cut in Reach Up benefits for certain recipients with disabilities, a cost-cutting measure in the current fiscal year’s budget. Ed Paquin, executive director of the group Disability Rights Vermont, pointed Wednesday to declining enrollment in Reach Up as proof the program helps lift people out of poverty. He said the $4 million net savings from reduced Reach Up rolls should be reason enough to repeal the cuts. ...

The Reach Up cuts save the state around $1.6 million a year. ... A federal class action lawsuit filed last summer by Vermont Legal Aid claimed the cuts unconstitutionally discriminated against people with disabilities.

In November, the law’s constitutionality was upheld. But in his decision, U.S. District Court Judge William Sessions expressed disappointment over the policy.