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Ssd No Longer Qualifies For Reduced Fee- Lara Changes The Rules Again.


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Another Unannounced Change from LARA

 
12 June 2013
Dr. Robert Townsend
 
The series of house bills passed in the wee hours of the morning in the closing days of the last session went into effect April 1st this year.  As some of you know, this was a Monday.  The previous FRIDAY afternoon, LARA changed all the application forms, leaving all certification physicians in the state scrambling over the weekend to be in compliance.
 
Once again, we have an unannounced change to the process designed, in my opinion, to create another series of denials for patients.  With no notice or announcement to the certification community, LARA has quietly REMOVED SOCIAL SECURITY DISABILITY from the reduced ($25) fee, leaving only full Medicaid and SSI (with paperwork proving SSI dated within 2 rather than 3 years of the application)...
 
I'm Dr. Bob Townsend.  As an individual, I am outraged at this development.  As a thinking individual, I look at the pattern of behavior by LARA as a broad based effort to undermine the MMMA program they are charged with administering.  
 
The following are, as I see it, clear indications of malintent on the part of these program administrators.
 
1.Sudden and in many cases unannounced changes in application forms just prior to implementation of various parts of the Act.  They changed the form literally days before the MMMA went into effect in 2009.  They changed the application form at the very end of the work week prior to the change in the Act on April 1st, and now quietly removed a major qualification for the reduced fee without informing those of us working in the field.  The change to eliminate SSD can only be found if one goes to the state website and clicks on the link to either the qualifying paperwork for the reduced fee or the actual application form, which was revise 6/13 to remove SSD.
 
2.Prior to April 1st, certification applications were routinely rejected if a box was not checked listing the qualifying condition.  This despite the qualifying condition being clearly written in the 'remarks' section under the boxes by the certifying physician.  When asked about this, representatives of LARA indicated they did not have people 'qualified to interpret clinical notes'.  Now that they have taken it upon themselves to require an explaination of the cause of a patients chronic pain written next to the checked box for chronic pain, they routinely reject the certification if a 'cause' of the chronic pain is not written in.  Apparently they have now learned how to read if it allows them to reject applications.
 
3.Despite hand picking the medical review panel charged with voting on new conditions, once positive votes were taken on PTSD and Parkinson's Disease, both votes were invalidated based on the fact that even though the votes were 5-2 of the 7 individuals present for the votes, there were 13 members named to the panel and supposidly a clear majority of 7 positive votes was deemed 'required'.  Then they claimed the make up of the panel was invalid by their own rules and had to be dissolved.  Both actions occured on the last day allowed for action on the votes.  One has to wonder if the conditions were voted down, we would have ever heard of any objections by LARA to the makeup of the panel.  
 
4.While no expert on Robert's Rules of Order, I do believe that in the case of all members of a panel not being present for a vote, the vote is allowed if there is a quorum (in this case 7 of the 13 were present and were a quorum) present, and the vote could be carried by a simple majority of the members present and voting.  If correct, the months of work and testimony on behalf of PTSD and Parkinson's Disease were passed by a vote of 5-2 by LARA's hand picked new condition panel.
 
5.While tightening the requirements for certification, restrictions on P2P, and even the transportation of cannabis medicine by licensed patients in vehicles was regulated, NOTHING was done to address job security for cannabis patients, to encourage physicians to participate in the program (without the interference of their employers, clinics, or hospitals), or to increase access to medication by patients.
 
The overall picture I see is one of an agency that is doing everything it can to try and make the program it was 'forced by the voters' to administer fail. Application forms are rejected on a whim due to unannounced changes and unrequired explanations.  Lip service is paid to the parts of the law designed to improve access for patients (the new condition panel), while every imaginable roadblock to make it harder for patients to qualify for the card, obtain medication, or move it is tossed up by the department and legislature.
 
We have had some victories.  In Koon, actual 'impairment' was made the standard for driving.  This was only common sense, cannabis stays in the system and many patients are clearly NOT impaired even though a blood test may reflect they had used cannabis hours before and tiny traces remained in their system.  One can only wonder if Walmart Joe would still have his job if the same standard was applied.  I am glad the SC ruled that the standard practice of 'we don't know what level results in impairment, so let's arrest everyone' is no longer acceptable.  However the same court overruled Green and patient access suffered.
 
I don't agree with removing from the list of qualifying reasons to get a reduced fee or refusal to give a reduced fee to disabled veterans, but I don't believe there is an absolute requirement under the law to give anyone a discount, so I guess we should be glad we still have SOME qualifying reasons to get a reduced fee.  I don't think a program with a $10 Million dollar surplus should still be charging the maximum fee allowed to patients that are ill and underemployed and least likely to be able to afford those fees.  I don't think we should have to wait a year past the deadline for an annual report on the program, or that 3 years should pass without a new conditions panel being seated because the regulatory agency doesn't know it's own requirements for the panel or have a 'form' requesting a new condition be added written.
 
I am not a lawyer, I am not an expert in Parliamentary Procedure.  But looking at the way this program is run by the state, I can recognize a stonewalling when I see one.  Call your representatives and senators and tell them you- a voter from their district that helped put them in office, can see a stonewalling too.  Ask them what they plan on doing about it.
 
Dr. Bob

- See more at: http://www.drbobmmj.com/156-news/289-another-unannounced-change-from-lara.html#sthash.tghR8HWd.dpuf

Edited by Dr. Bob
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Nice post Bob.

 

It gets old quick dealing with this government.  I can only hope we make enough changes next election to be able to foster in some new administrators for our program.

 

But, just to clarify a tad bit on the reduced fee issue:

 

 

 

SSI and Medicaid(State run) are made for "poor" people.  I happen to be one of those people.  I am disabled and qualify for disability.
 
People that are on SSDI(federal), if poor, qualify for SSI and Medicaid as well.
 
They have financial levels you must use to qualify for it.
 
 So, I have all the outrage that regardless of income level, someone whom is disabled should get the discount and I will join the chorus for reinstatement of SSDI as a lowered rate qualifier.
 
 But, just because you are disabled, doesn't mean you are "poor" so to speak.
 
And, it is ridiculous that notifications weren't mailed to all lowered rate patients who are already in the program. 

 

Here is the New:

 

Reduced Fee Eligibility

 

 Just more nonsense.

 

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And so people understand the difference between "full Medicaid" and Partial Medicaid"

 

http://www.hapnetwork.org/assets/pdfs/duals-overview.pdf

 

 

What Is Meant by "Full Dual Eligible" and "Partial Dual Eligible"?

Dual eligibles are either "full" or "partial" depending on the level of Medicaid benefits that they qualify for.

Full dual eligibles: Medicare beneficiaries who are enrolled in a Medicaid program that provides Medicaid health coverage, as well as assistance in paying the beneficiaries’ Medicare premiums and cost-sharing. Medicaid programs that offer "full" Medicaid benefits include the SSI eligibility category and the low-income or medically-needy elderly or disabled.

Partial dual eligibles: Medicare beneficiaries who are enrolled in a Medicaid program that does not offer Medicaid health coverage, but does provide assistance in paying Medicare premiums and other out-of-pocket costs. Medicaid programs that provide "partial" Medicaid benefits include Medicare Savings Programs (QMB, SLMB, QI, and QDWI). HAP has more resources on Medicare Savings Programs available online.

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LARA already has a surplus on the MMMP, they should have lowered the price.

i predict in the future they will raise the price. i think they did this in oregon.

 

great writeup dr bob, but i think it will fall on deaf ears in our government.

 

one thing, the MSC didnt agree to hear people v green yet.

some say mcqueen ruling overrides it, but thats harder to predict.

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Thanks for the follow up Mal, between the two write ups I think folks have a better understanding of the reduced fee program and who does and does not qualify.

 

Appreciate the comments folks, every now and then I just have an urge to vent my spleen and this was one of those times.

 

Dr. Bob

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Thanx Dr. Bob I was not aware of this. Yes another attempt to mess with this law and coming from the agency that is supposed to be SIMPLY issuing cards. What a joke....... They are not smart enough to realize all of their fighting against this MEDICAL law they are just going to push the full on LEGALIZATION effort.  As people realize they are still messing with the medical patients on this issue, these people will say fukkit just legalize it already. They are digging their own grave on this issue and giving the legalization effort more and more steam. Yet they are not smart enough to figure that out.

 

Fukk them and fukk their little card........ LEGALIZE.......

 

 

Edited to add..... They already have a major surplus in this program yet they pull this? And with no notice, nothing on the website to point it out? They hope that while you are being denied ,because you did not know about the reduced fee change which will affect MANY, they can bust you for non compliance on a TECHNICALITY caused by LARA. We are in a war against the very agency running this program.

And the whole panel thing? Yea sure it was just an oversight........ Most people thought the panel was moving along nicely, Yet we were being dupped the whole time.......

 

Glad they continue to make these changes TO HELP THE PATIENTS........

 

Anyone STILL think they ever intended to give us a fair shake even though 63% of the state said to?

 

And I thought renewing this year was going to be hard as it is...... BAMMMM another thing piled on....... Maybe I wont be able to renew this year afterall.

Edited by ozzrokk
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LANSING- In an unannounced policy change, the Licensing and Regulatory Affairs Department has made it more difficult for the disabled to enroll in the state Medical Marihuana Program (MMP) by removing a discounted registration rate that had existed for five years.


The change was not announced via press release or through letters sent to discount recipients. Patients and caregivers reported seeing a new chart on LARA’s website to operators of certification centers and other related businesses. The chart is called “Supporting documentation for reduced fee eligibility” and indicates that it was revised  on 6/2013. Disability is now listed as ‘not eligible’ for a discounted rate; the registration fee is normally $100 and the discounted rate is $25.


View the new chart HERE.


“It seems really unfair to do that without a public hearing,” said Matthew Abel, an attorney with the firm of Cannabis Counsel and the current Executive Director of Michigan NORML.


This is the second time LARA has changed longstanding policy under new head Steve Arwood, appointed by Governor Snyder earlier this year. Soon after his appointment Arwood bounced MMP head Celeste Clarkston and disbanded the New Conditions Panel of mostly physicians that endorsed adding Parkinson’s Disease and Post-Traumatic Stress Disorder to the list of conditions qualifying a person to receive a recommendation to use medicinal marijuana. He then discarded their recommendations and has announced he will compose his own advisory board of physicians.


The panel was assembled with much fanfare in 2012, after a four year delay, had met several times and proposed to consider two new conditions to the list, asthma and autism. Clarkston reported in media during 2012 about the careful and precise composition of the Panel during its formation; Arwood’s reason for dismissing the Panel is that the membership was not appropriate. Also gone is longtime member of the MMP staff Rae Ramsdell, leaving the MMP leaderless and being steered by Arwood.


Read the MMP’s Administrative Rules HERE.


Arwood is systematically applying a new, more restrictive reading to existing administrative rules. “What LARA is doing right now is changing the rules without any oversight,” said Abel. The disability discount has been in place since the very first applicants dropped off their paperwork to the Department of Community Health in April of 2009. A patient could have filed their original application and four renewal applications- all of which were approved- only to now be told that it was all a mistake.


“What bothers people the most is they are changing the rules without any input or discretion,” said Bob Redden, whose criminal case stretched out over more than 1,500 days in the Oakland County court system and is now a frequent observer at many marijuana trials and hearings. Redden is a veteran who walks with a cane. “Look what they did to the New Conditions Panel. They decided to change the rules midstream,” he adds.


“Who are they taking their orders from?”


When queried about the changes, a telephone operator at LARA stated management told them the discount was not allowed under current Administrative Rules and that her supervisor Mrs. Williams was handling complaints about the change. She also said the Rules were going to undergo a complete overhaul in the near future. The change also affects those collecting Medicare and Medicaid- now only those receiving FULL Medicaid (not Medicare) will be able to claim the discount.


Redden sums up the frustration of an entire community when he says, “Does the will of the people mean anything at all?”


LARA’s representative stated the new rule went into effect for all applications received after May 29, 2013.

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well I am on ssd and I don't  qualify for SSI and Medicaid as well they told me I make to much 3 bucks over so I don't know how lara can just say F you all you on ssd

Nice post Bob.

 

It gets old quick dealing with this government.  I can only hope we make enough changes next election to be able to foster in some new administrators for our program.

 

But, just to clarify a tad bit on the reduced fee issue:

 

 

 

SSI and Medicaid(State run) are made for "poor" people.  I happen to be one of those people.  I am disabled and qualify for disability.
 
People that are on SSDI(federal), if poor, qualify for SSI and Medicaid as well.
 
They have financial levels you must use to qualify for it.
 
 So, I have all the outrage that regardless of income level, someone whom is disabled should get the discount and I will join the chorus for reinstatement of SSDI as a lowered rate qualifier.
 
 But, just because you are disabled, doesn't mean you are "poor" so to speak.
 
And, it is ridiculous that notifications weren't mailed to all lowered rate patients who are already in the program. 

 

Here is the New:

 

Reduced Fee Eligibility

 

 Just more nonsense.

 

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well I am on ssd and I don't  qualify for SSI and Medicaid as well they told me I make to much 3 bucks over so I don't know how lara can just say F you all you on ssd

 

 

Not only will they give us a big F U.............. They will also try to trip you up in the process.......... Welcome to America. I am told that is how the system works......

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Looks like it is time to review and copy the current rules to see what the changes are.  Perhaps someone can explain this to me.  I believe administrative rules are designed to put the law into effect by coming up with the forms, the documentation, etc, not to change the intent or practice of the law itself.

 

Dr. Bob

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Looks like it is time to review and copy the current rules to see what the changes are.  Perhaps someone can explain this to me.  I believe administrative rules are designed to put the law into effect by coming up with the forms, the documentation, etc, not to change the intent or practice of the law itself.

 

Dr. Bob

There is no intent to provide discounted fees in the law, expressed or implied. Administrative law is a different animal from statutory law and common law. If you have a problem with administrative rule changes your options are to bring mandamus action to compel (you will prevail if your argument has enough merit), to approach your legislators, or perhaps more appropriately the governor, to address the issue, or to live with it. Which will you do?

 

Glad I could help.

Edited by GregS
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There is no intent to provide discounted fees in the law, expressed or implied. Administrative law is a different animal from statutory law and common law. If you have a problem with administrative rule changes, your options are to bring mandamus action to compel (you will prevail if your argument has enough merit), to approach your legislators to address the issue, or live with it. Which will you do?

 

Glad I could help.

Knock yourself out Greg- file the action if you can find time between your efforts to discover the name of my residency program director.  Unfortunately you missed the point being made.  

 

The administrative rules are being used by the department to impair the Act by adding unnecessary requirements, unannounced rule changes, etc. designed specifically to generate denials, clog the system, and frustrate rather than streamline the process for the patients.  The end result is an effort to slow the implementation of the law, violate the intent of the law itself (patients have access to certification and medication), etc.

 

For the record and to put this issue to rest, I did respond to Greg a couple of months ago as far as his request for my background information.  I told him about my experience as a paramedic in Lansing and Fl, completion of my medical school in Fl and residency in IM in Ohio, my work in private practice in internal medicine, and the legal work on section 8 defenses I've done, etc.  He wasn't satisfied.  He wanted program directors, work history, etc as if he was doing an employment background check.  That really isn't important and I told him so.  That is what lead to this constant harassment about my CV.  

 

I realized some time ago that he was a kook and any answer I gave him wasn't going to be 'enough' so I stopped bothering with responding to him, to the point of putting him on ignore.  I just let him spin his wheels.  But his constant implication that I am not answering because I have something to 'hide' is becoming bothersome.  The truth is I am not answering because it drives him insane.

 

Most folks in here seem to have come to the same conclusion, so I'd just as soon let it drop and get on with important things.  If anyone has any serious need to know my work history, I'll be happy to tell them in PM on one condition....they don't tell Greg.  He doesn't know the secret handshake yet and can't know the secrets of the temple...lol

 

Dr. Bob

Edited by Dr. Bob
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Snyder took up the ball that Engler was running with. It looks as though Snyder is following in Engler's footsteps. One of Engler's favorite things to do was to make wholesale changes in government agencies without any input from legislators or the public. If people complained his response was basically "So sue me!". Snyder hasn't been quite as brazen as Engler was, but even so he has made major changes in the State simply through executive orders.

 

Republicans hate government. To understand why they hate government. you first have to understand who the Republicans are who pay the bills. They are business owners who don't like the government telling them that they can't pollute at will. They are rich people who don't like the IRS taking their money and giving it to poor people. They are religious fanatics who don't like government schools teaching their kids about science and "other ungodly ideas". Snyder is their champion in Michigan and they don't want "Marijuana:The Evil Weed!" in their state.

 

Republicans are self-centered egomaniacs whose understanding of the world doesn't extend beyond what the Bible tells them. They don't like marijuana because of its ability to expand consciousness and make people question the world view of the Bible thumpers.

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