Wednesday, January 27, 1999



Home health patient
says service cut illegally

By Helen Altonn
Star-Bulletin

Tapa

Big Islander Nathan Morris has suffered two life-threatening incidents in five years, say attorneys Elizabeth Croom and David Simons.

The first was a traffic accident that left the 40-year-old a quadriplegic; the other, elimination of Medicare home health services.

Croom, with the Legal Aid Society of Hawaii, and Simons filed a federal lawsuit yesterday alleging that Kohala Home Health Care illegally cut off Morris' services last March.

The defendants are North Hawaii Community Hospital and Adventist Health of California, a national health management organi-zation which oversees the hospital and its home health agency.

The lawyers are seeking damages for alleged violations in denying medical care. They also ask for injunctive relief to restore services to the disabled father of four.

Honolulu attorney Ken Robbins, representing the hospital, said the issue boils down to the definition of "homebound" under state and federal laws.

He said Morris was receiving Medicare home health care as a "homebound" patient but was observed regularly outside the home.

After conferring with Morris' physician and the Health Department, the Kohala agency felt Morris no longer qualified for Medicare home services, he said.

Croom and Simons said thousands of Medicare beneficiaries nationally are being denied home health care services because of 1997 reimbursement caps. Agencies feel they'll lose money on "heavy users," Croom said.

She said the maximum Medicare payment to Kohala Health per patient is estimated at about $3,000 aml6 Nathan

Morris year. Morris' services totaled about $2,500 a month, but costs for Medicare patients balance out because many need only minimum care, she said.

Robbins said, "I can tell you unequivocably this decision had nothing to do with finances. I don't know of a hospital more concerned and more caring with respect to the people they serve within their small community."

Croom said federal Medicare Administrator Nancy-Ann Min DeParle wrote to all Medicare-certified home health agencies after reports that they were dropping homebound patients because of payment changes.

DeParle told the agencies they can't reduce care ordered by physicians for Medicare enrollees and that agencies doing so inappropriately could be dropped from the Medicare program.

Simons and Croom said they were able to get services restored in four other cases of unfair denial identified through Legal Aid's Big Island Medicare Advocacy Project. Three were with Kohala Home Health and one with Interim Healthcare, Croom said.

Simons said they didn't want to go to court in Morris' case and tried for months to get services restored.

A former union laborer and equipment operator, Morris said he was driving home from work Nov. 4, 1994, when another car forced him off the road.

He has the use of his upper arms but no hand function and no feeling or movement below his chest. He needs help getting out of bed, bathing, getting into an electric wheelchair and other functions of daily living, he said.

He has a catheter and related life-threatening problems that need constant monitoring, Simons said.

Kohala Home Health began providing Morris health care services in February 1995, after he was treated at Queen's Medical Center and the Rehabilitation Hospital of the Pacific, Morris said.

He said the agency had a policy then of taking care of anyone regardless of ability to pay and REHAB wouldn't have released him without services available.

But in March 1996, the agency dropped him because of a two-year waiting period for Medicare benefits. The agency picked him up again in May 1997, after the two years, he said.

In February 1998, he was told by telephone that Medicare rules had changed and the agency couldn't cover him any longer, he said.

He said the trouble began when he insisted on a written explanation. "They told me if I persisted in asking for a written statement, they would find me not homebound."

He said the agency tried to get him set up for Medicaid benefits but he didn't want welfare assistance as "a matter of pride."

Robbins said the home health agency tried to assist Morris in getting state Nursing Home Without Walls services but he chose not to participate in it.

"No one is denying that he needs nursing care," Robbins said.

Dr. Sylvia Sonnenschein, Morris' physician, said she never gave permission for Morris' discharge and that he should have Medicare services.

"Homebound doesn't necessarily mean they can't go out," she said. "That doesn't make sense. You want someone to get out and not be strapped in bed."

Sonnenschein and volunteers are continuing to help Morris and other disabled patients. "These people are sitting here," she said. "They need things now. They can't wait for a year for a lawsuit."

Tapa

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Judge orders repayment
of benefit reductions

By Debra Barayuga
Star-Bulletin

Tapa

Four Hawaii general assistance recipients had their day in court.

Acting Circuit Judge Rhonda Nishimura yesterdayordered the state Department of Human Services to pay John Cosgrove and three others the difference between $418 and $340 a month.

The residents had accused the department of failing to adopt proper methods for calculating benefits when it reduced them.

But the judge denied across-the-board relief to all other general assistance recipients, said Barbara Fabrey, attorney for the Legal Aid Society, which filed suit on behalf of four plaintiffs.

The Hawaii Supreme Court on Sept. 15 struck down administrative rules the department used to reduce benefits from $418 to $340, saying they were "invalid and unenforceable."

The payments to the plaintiffs would be for the period of Sept. 15 to Dec. 31, 1998.

Public hearings have been since held on the department's latest proposed rules, which are awaiting the governor's signature. The department, however, has since increased general assistance amounts from $340 to $388, effective the beginning of the new year.

"The court found that since we have made a determination and set out a method, that that method would prevail," said Bryan Yee, deputy attorney general.

Yesterday's decision does not change the amount the department will pay for general assistance. And benefits to the rest of Hawaii's general recipients won't be reduced, Yee said. "We're happy the order will not negatively impact the rest of the general assistance population."

The state is primarily interested in keeping general assistance levels as steady as possible and as high as possible within the department's appropriation, Yee said.

If there's money left over, recipients would receive a supplementary check at the end of the fiscal year.

There are about 5,500 disabled people in Hawaii who receive general assistance because they are unable to work and have no other means of support.



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