Daily Archives: August 26, 2020

I love you. . . when a spouse says it to their husband or wife, its happy words that re-establish over and over again steadfast endearment, affection, loyalty and it rejuvenates that special bond between two people. Three little words you never tire of, regardless of the longevity of your relationship just engaged, newlyweds or 50+ years together hanging in there through thick and thin, hard times and good times when as a couple you saw everything through together. Bills, ailments, illness, worries and lifes challenges, knowing as a team ordained by God, you could take on the world through sickness and health, life and death. That sweet expression of I love you lasts forever and ever and the miles between Heaven and Earth dont change a thing. Love is love and it is precious. And when a parent says it to their son or daughter, regardless of age, and especially if our children temporarily break our heart, those words bring joy, happiness and security. When a child says it to his/her mom or dad again, regardless of age, they are words we never feel are overstated. Love is the greatest gift.

In my case, I truly, absolutely love everybody and I say it a lot! In fact, folks might think I overdo it, but I hope not. When I recently met with a veteran to assign his Dare County Veteran Discount Card and I started to drive away, I said to him, Love ya! and I meant it. It didnt matter to me if I had never seen him before, I was happy to meet him and thank him for his service. After I got home, I thought, Gee, he didnt even know me . . . wonder if he thought I was a little kooky or something! So I texted him to explain that this is me Marsha M. Brown maybe different than a lot of folks for sure, but well-meaning and sincere.

Im sorry and I forgive you offer peace within our soul to know that if we made a mistake, let someone special down or really blew it, we can tell them were sorry and hopefully they can and will forgive us realizing that none of us are perfect. Sometimes we just plain made a mistake, we misunderstood, we truly forgot or we unintentionally stepped out of line. The hope and assurance the disappointment we might have caused will not be held against us makes a world of difference, because the human aspect is plain and simple we goof up sometimes, not because we mean to, not because were mean spirited or selfish and self-centered. And besides, most of the time, when we let someone else down, in retrospect, the act itself hurts us more deeply. Personally, I fall short of the forgiveness of God way too often. I dont study the Word like I should. I dont take as good a care of my body as I should. I say bad words if I step on something that hurts or Im chased by a swarm of wasps trying to get into the truck before I do or if I forget to do something important that bad word slips out as smooth as melted butter and as quick as a duck on a June bug!

Good job! is seldom heard enough in the workplace. Maybe sometimes supervisors or managers think that if they say it too often, the person theyre praising will get a little cocky, overly confident or too sure of themselves so they hold back, but as the voice of experience and for all the close to 40 years I have been a Realtor, I have been privileged to work for a firm on the Outer Banks that I work for today. Years ago, before I went into full times sales, I was a property manager on Hatteras Island Salvo to be exact and my boss, Janice A. Farr, senior vice president of property management at Sun Realty, who doesnt personally care for the title boss, set an example that I have not experienced since.

She offered to help me whenever I needed guidance; she encouraged me to be the best I could be and she praised my work. She wasnt overboard with it with empty words and meaningless compliments, but she fairly and honestly pointed out my good traits as an asset to the company, which kept me wanting to keep on keepin on to make her proud. She was a hero to me in the workplace and beyond and still is. I loved her then and I love her now. To know Janice is to love Janice.

We all need kind words no matter where we work or what we do. We are human after all, and I think God instilled in all of us the ability to lift others up to a higher plane, to help us see our potential, our value, our worthiness as employees, staff and associates and to help us grasp our contribution to making life better for not only ourselves but for others too. Though I am now in real estate sales, the ten years under her direct supervision were ten of the happiest working years of my life. (Note: it was Janice Farrs daddy W. Chris Aydlett Sr.s celebration of life service that I wrote about in Gig Line, The Sanctity of Life.)

Thank you! Two words that express gratitude. A million times . . . I thank you . . . all of you. The first Gig Line I wrote in March 2012 about my sweet Billys coming home from Vietnam. It was the story about how his return, his outlook on life and his maturity as a vet, grew me up! He and I werent dating when he was deployed in 1966, but after his return in March 1968, God brought us together through a tragic event in my life and from that point, he matured and transformed a 17 year old new graduate of Manteo High School into a young woman who suddenly saw life through his eyes. It was then that I learned what sacrifice really meant, what patriotism was really all about and what riches we as Americans have in our veterans. At 17 we were married and it was nothing but the grace and love of God that gave me the honor and privilege of being married to William S. Billy Brown Jr.

What has that got to do with saying thank you to all of you? Ill tell you . . . because when I wrote that first Gig Line, my sweet husband was proud not because it was about him it was because Gig Line brought to the forefront a personal perspective on Vietnam veteran brothers and sisters, some of what they went through and from that time almost eight years ago, I have continued to write about Billy, brotherhood love of our veterans, their sacrifice that unintentionally taking them for granted. Through that, I have been blessed beyond measure.

Thank you to all the veterans who have called, emailed or snail mailed me over these years. My Billy is in Heaven four years now, but Im contacted sometimes by the men and women who read my column who dearly loved their veteran husband, wife, brother or other family member too who is now up there with Billy. Anna, Wendy, Barbara S., Cathy, Therese, Lee B., Barbara L., Liz, Polly, Valerie, Anna, Peggy, Janice and Alline (my Billy was a hunk a hunk of burning love too!) and literally countless others. My one true love inspired me to write Gig Line, a name we created together. Then in reading it, you all touched Billy, which made him happy; then you inspired me to continue to write it and over time, we have become a veteran community all in its own and that my friend has made me very thankful. I am currently in the process of writing a book and I cannot wait until its ready to be out there!

Until next time, you made my Billy proud, which makes you all precious to me. I love you all! Stay healthy, safe and proud of the veteran you love and were loved by and if he or she is no longer with us, thank the good Lord for the time they were. Love the person God created you to be He doesnt mess up! You are special, you are unique and you are the only you there is. Embrace that, okay? Thank you to all our veterans, active duty and military wantabees! And please keep wearing your masks because its helping keep all of us safe!

If you want to talk, or you know a vet or family member who could use some help, please call/text me: 252-202-2058 or email me: giglineheroes@aol.com or for the real expert in the matters of Veteran Affairs, contact our Dare County Veteran Service Officer, Patty OSullivan 252-475-5604 or email her: dcvac@darenc.com Patty is very diligent about follow up phone calls, so if you call and she doesnt answer, please leave a detailed message with your name, phone number and if you would like, the reason for your call she will call you back and she will do everything she can to help you, I promise! Love yall and please stay tuned!

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Gig Line: A few words that can change the world - The Coastland Times - The Coastland Times

Fruit is packed with vitamins, minerals, fiber, and plant compounds called phytonutrients. As such, its one of the healthiest foods you can eat.

Some fruits are even considered superfoods due to their numerous benefits. Even though theres no exact definition of what constitutes a superfood, theyre often rich in health-boosting compounds with antioxidant and anti-inflammatory properties (1).

Many fruits have been studied for their health effects. Although its clear that total fresh fruit intake is an important factor in disease prevention, certain fruits stand out due to their robust nutrient content and associated benefits (2, 3).

Here are 25 super fruits to add to your diet today.

In addition to their pleasing taste, plums offer a high concentration of vitamins, minerals, and health-protective plant compounds (4).

Theyre particularly rich in hydroxycinnamic acids, which are a type of polyphenol antioxidant. By reducing cellular damage caused by unstable molecules called free radicals, antioxidants may reduce your risk of various diseases (5).

Plums are also rich in vitamin C and provitamin A carotenoids, both of which have antioxidant and anti-inflammatory properties (6, 7, 8).

Strawberries are particularly high in antioxidants like vitamin C, anthocyanins, phenolic acids, and flavonoids (9).

In a 3-week study, 21 women who ate 9 ounces (250 grams) of frozen strawberries daily experienced a significant increase in antioxidant activity in their blood (10).

Whats more, these healthy berries may slash your risk of disease.

Research suggests that eating strawberries may help reduce heart disease risk factors, lower inflammatory markers, and increase fiber intake, all of which may protect against chronic health conditions like heart disease and certain cancers (11, 12, 13, 14).

Despite their small size, grapes pack a serious nutritional punch. Many varieties exist, and while all make a healthy choice, some are higher in antioxidants than others.

In a recent study comparing 30 grape varieties, Black Pearl, Summer Royal Black, Pearl Green, Seedless Green, and Seedless Red grapes exhibited the strongest antioxidant and free-radical-scavenging activities (15).

These varieties were found to be packed with antioxidants like caffeic acid, epicatechin, catechin gallate, protocatechuic acid, gallic acid, and rutin (15).

Indeed, these antioxidants may be the reason why these tasty fruits are associated with a reduced risk of heart disease and certain cancers (16).

Apples are associated with a variety of health benefits, including a reduced risk of heart disease and several cancers, including colorectal cancer (17, 18).

Notably, theyre a concentrated source of flavonoid antioxidants.

A study in over 56,000 people linked a higher intake of apples and other flavonoid-rich foods to a reduced risk of death from all causes, including from cancer and heart disease (19).

Peaches are often enjoyed in jams and pies, but its best to eat peaches raw.

Thats because fresh peach peels and pulp have higher antioxidant and anti-inflammatory activity than cooked peach products (20).

In addition to phytonutrients like phenolic acids and carotenoids, peaches provide a good source of fiber, vitamin C, provitamin A, and potassium (21).

Avocados are not only creamy and delicious but also packed with nutrients like fiber, healthy fats, potassium, magnesium, folate, and vitamins C and K1 (22).

In fact, studies suggest that these fatty fruits may help reduce weight, blood sugar levels, and heart disease risk factors like LDL (bad) cholesterol (23, 24).

The impressive benefits of blueberries are well documented.

These berries contain several potent antioxidants and are especially rich in anthocyanins, which are plant pigments that account for up to 60% of their total polyphenol compounds (25).

Eating fresh blueberries each day, even in moderate amounts of 1/3 cup (113 grams), has been linked to a reduced risk of heart disease and type 2 diabetes, as well as slower rates of mental decline in older adults (25).

Thanks to their high concentration of vitamin C and polyphenol antioxidants, cherries have powerful anti-inflammatory properties (26).

Both sweet and tart cherries as well as their juice and powder are associated with many health benefits.

For example, a review of 29 studies found that consuming these foods led to reductions in markers of oxidative stress and inflammation, as well as decreased blood pressure, VLDL cholesterol, and HbA1c a marker of long-term blood sugar control (26).

Grapefruits may help improve the nutrient content of your diet. A review of studies in over 12,000 people showed that people who ate this citrus fruit had higher intakes of magnesium, vitamin C, potassium, and fiber, compared with those who didnt eat it (27).

Plus, the analysis found that women who ate grapefruit had lower body weights, as well as lower levels of triglycerides and the inflammatory marker C-reactive protein (CRP), plus higher levels of HDL (good) cholesterol (27).

Blackberries are packed with anthocyanin pigments, and evidence suggests that eating them regularly benefits your health.

An 8-week study in 72 people with high blood fat levels gave one group 10.1 ounces (300 mL) of blackberry juice and pulp daily.

Those who drank this combo experienced significant reductions in blood pressure and CRP levels, as well as significant increases in HDL (good) cholesterol, compared with a control group (28).

Black chokeberries (Aronia melanocarpa) are native to eastern North America and typically found in jams, juices, and pures. Theyre a concentrated source of phenolic acids and flavonoids, including anthocyanins, proanthocyanidins, and flavonols (29).

In a 12-week study, 66 healthy men who consumed chokeberry powder and extract daily experienced improved blood flow and increased blood levels of phenolic antioxidants, which may improve heart health (30).

Although often considered a vegetable, tomatoes are a type of fruit.

Theyre one of the richest sources of lycopene, a carotenoid pigment thats associated with powerful heart benefits (31, 32, 33).

It should be noted that tomato peels contain significantly higher levels of antioxidants than the pulp. For this reason, be sure to enjoy tomatoes and tomato products unpeeled (34).

Figs are fiber-rich fruits that also pack other nutrients like magnesium, potassium, calcium, and vitamins B6 and K1 (35).

Whats more, theyre loaded with polyphenol antioxidants, which have been shown to have numerous benefits. In fact, figs are a more concentrated source of these beneficial compounds than red wine or tea (36).

In addition to being high in polyphenol antioxidants, raspberries are one of the richest sources of fiber among all fruits and veggies (37).

Test-tube and animal studies suggest that eating these berries may reduce your risk of heart disease, type 2 diabetes, and Alzheimers, though human research is needed (37).

Blood oranges are a sweet orange with a reddish rind due to their high levels of anthocyanins (38).

Theyre also loaded with vitamin C, a water-soluble vitamin that acts as a powerful antioxidant. In fact, blood oranges typically contain 3242 mg of vitamin C per 3.5 ounces (100 grams) or 3547% of the Daily Value (DV) for this vitamin (38).

Nectarines are high in vitamin C, beta carotene, and numerous other antioxidant compounds (39).

Consuming beta-carotene-rich fruits like nectarines may help reduce disease risk and early death. One review of studies in over 174,000 people associated beta carotene intake with a significantly reduced risk of death from all causes (40).

Many studies tie pomegranates to a variety of health benefits. These fruits boast compounds like ellagitannins, anthocyanins, and organic acids, which give pomegranates potent antioxidant activity (41).

Human research reveals that pomegranate juice and extracts may help reduce oxidative stress, blood pressure, LDL (bad) cholesterol, triglycerides, inflammation, and muscle damage. Animal and test-tube studies suggest anticancer properties as well (41, 42, 43).

Kumquats are small, orange-colored citrus fruits with tart flesh. Theyre high in health-promoting nutrients and plant compounds like vitamin C, polyphenols, and carotenoids (44, 45).

Theyre native to China, where theyve been used as a natural treatment for coughs, colds, and inflammatory conditions for centuries (46).

Mangos are a popular tropical fruit full of antioxidants, including gallic acid, quercetin, and ellagic acid, as well as the carotenoids lutein, alpha carotene, and beta carotene, which give the fruit its yellowish hue (47).

Mangos are also rich in fiber and may help promote healthy bowel movements.

In a 4-week study in 36 people with chronic constipation, eating 10.5 ounces (300 grams) of mango daily significantly improved stool frequency and consistency and reduced markers of intestinal inflammation, compared with an equivalent dose of a fiber supplement (48).

Goji berries are native to Asia, where theyve long been used as a functional food to promote health and increase longevity (49).

Due to their high antioxidant levels, these fruits are incorporated into tinctures, teas, and other herbal remedies to treat conditions that affect your eyes, liver, kidneys, and digestive system (49).

Goji berries are high in fiber, polysaccharides, phenolic compounds, and carotenoid pigments, which give this fruit its bright orange-red color.

Goji berries may protect your vision and lower blood levels of blood fats. Plus, they may have anticancer, immune-protecting, and brain-boosting properties (49).

Cranberries are packed with beneficial plant compounds.

Human and animal studies note that eating cranberries and cranberry products may lower certain blood fat levels and have anti-inflammatory, antioxidant, antibacterial, and anti-diabetes effects (50).

Cranberries are quite tart, so theyre often enjoyed dried and sweetened, or in sweet dishes like sauces and jams. To get the most benefits, opt for low sugar or unsweetened products.

Lemons are commonly used to flavor foods and beverages.

This citrus fruit is rich in vitamin C, essential oils, and polyphenol antioxidants (51).

Human studies show that daily lemon intake may help reduce blood pressure when combined with walking. Whats more, test-tube and animal research indicates that this fruit has strong anti-inflammatory, antioxidant, antimicrobial, and anti-diabetes properties (52, 53).

Packed with tropical flavor, papayas are rich in vitamin C, provitamin A, folate, and potassium. They also contain many antioxidants but are especially rich in lycopene (53).

Eating lycopene-rich fruits like papaya may protect against heart disease and certain cancers. Interestingly, lower lycopene levels are associated with an increased risk of death from all causes (54, 55, 56).

Watermelon is a hydrating fruit thats loaded with fiber, vitamin C, provitamin A, and many antioxidants. Animal studies demonstrate that it has powerful anti-inflammatory, brain-protective, and liver-supportive properties (57).

Whats more, watermelon is the richest food source of the amino acid l-citrulline. L-citrulline is needed for the synthesis of nitric oxide, a molecule thats essential for blood vessel dilation and other bodily functions (58).

This may be why human studies associate watermelon intake with lower blood pressure levels (59, 60, 61).

You may have heard of acai berries due to the popularity of acai bowls, a delicious concoction made with frozen acai berries and other fruits.

These berries polyphenol antioxidants may offer numerous benefits (62).

For example, human studies link acai berries and juice to higher blood antioxidant levels, protection against cellular damage, and reduced levels of blood fats, blood sugar, and insulin (62, 63, 64).

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25 Super Fruits to Add to Your Diet Today - Healthline

Key Takeaways

States have taken a number of Medicaid policy actions to address the impact of COVID-19 on seniors and people with disabilities, many of whom rely on long-term services and supports (LTSS) to meet daily needs and are at increased risk of adverse health outcomes if infected with coronavirus. Medicaid is the primary source of coverage for LTSS, financing over half of these services in 2018. Collectively these actions could expand access to coverage (by enhancing financial and functional eligibility criteria and streamlining enrollment), expand access to long-term care services (by adding new benefits and increasing utilization limits), and bolster providers (through increased reimbursement or retainer payments).Increased funding may be required to extend community-based care more broadly and additional enrollee protections and oversight could be achieved through strengthened reporting requirements.This issue brief identifies state actions taken as of August 21, 2020 and implications for future consideration.

States have taken a number of emergency LTSS actions related to Medicaid eligibility, benefits and providers (Figure 1). Over half of states have expanded eligibility criteria for seniors and people with disabilities, while few states have increased the total number of HCBS waiver enrollees served. Nearly all states have streamlined enrollment processes, and over one-third of states have eased premium and/or cost-sharing requirements for seniors and people with disabilities. Just over half of states have added a new LTSS benefit to meet enrollee needs during the emergency; most benefit expansions are home and community-based services (HCBS). Most states have increased service utilization limits and relaxed prior authorization requirements. Nearly all states have increased provider payment rates for at least one LTSS and modified provider qualifications, and many have adopted retainer payments. Among states with provider payment rate increases, just over half have increased institutional rates, while about two-thirds have increased rates for at least some HCBS. Few states have required reporting on COVID-19 cases and deaths for HCBS enrollees and/or settings. CMS has adopted separate COVID-19 reporting requirements for nursing facilities.

The duration of the public health emergency has implications for policy actions adopted under Medicaid emergency authorities as well as the availability of enhanced federal funding provided through the matching rate increase. Many state policy changes have been adopted through temporary authorities that will expire after the public health emergency declaration ends, which will lead policymakers to assess whether any policies can or should be retained and transitioned to other authorities. In addition, some policy changes in response to the pandemic may be difficult for states to sustain without additional federal financial support beyond the 6.2 percentage point increase in federal Medicaid matching funds authorized by Congress during the public health emergency, as states are facing revenue declines and budget shortfalls.

A great deal of attention has been focused on the impact of COVID-19 in nursing homes, given the disproportionate number of cases and deaths among residents and staff nationally, with less attention on community-based residential settings. The Trump Administration has issued guidance about how nursing homes should respond to the pandemic, announced the formation of an independent commission to assess nursing home response, and adopted new reporting requirements for COVID-19 cases and deaths in nursing homes. To date, less attention to COVID-19 cases and deaths generally has been paid to community-based residential settings, such as group homes, where the pandemic presents similar risks to Medicaid enrollees and providers due to the highly transmissible nature of the coronavirus, the congregate nature of the settings, and the close contact that many workers have with residents. Data about COVID-19 cases and deaths in both institutional and community-based congregate settings may allow policymakers to more fully assess the impact across populations at increased risk of adverse health outcomes. The pandemic also may exacerbate the need for HCBS waiver services, which already are subject to waiting lists in a number of states. For example, elderly parents sickened by COVID-19 may no longer be able to provide care for their adult children with disabilities. Beyond the pandemic, the coming age wave makes LTSS and Medicaids role as the primary payer likely to be policy issues faced by the next Administration, in addition to the continuing effects of the pandemic and economic crisis.

As the COVID-19 pandemic continues, states have taken a number of Medicaid policy actions to address the impact on seniors and people with disabilities, many of whom rely on long-term services and supports (LTSS) to meet daily needs and are at increased risk of adverse health outcomes if infected with coronavirus. Medicaid covers nearly 7.4 million seniors and almost 11.1 million people who are eligible based on a disability as of 2014. These enrollees may be at increased risk for adverse health outcomes if infected with coronavirus due to their older age, underlying health conditions, and/or residence in congregate settings, such as nursing homes, intermediate care facilities for people with intellectual or developmental disabilities (I/DD), or group homes. In addition, many seniors and people with disabilities rely on Medicaid LTSS to meet daily self-care and independent living needs, which makes it important for their coverage and access to care to continue uninterrupted during the pandemic.

Many state policy changes related to Medicaid LTSS have been adopted through temporary authorities that, according to CMS guidance, will expire when the Health and Human Services Secretarys COVID-19 public health emergency declaration ends. This will lead policymakers to assess whether any changes can or should be retained and transitioned to other authorities. The public health emergency declaration currently is set to expire on October 23, 2020. While some state actions have been supported by the 6.2 percentage point increase in federal Medicaid matching funds authorized by Congress during the public health emergency, policy changes may be difficult for states to sustain without additional federal financial support, given the severity and expected longevity of the economic crisis resulting from the pandemic. The amount of fiscal relief to states from the increase in federal matching funds depends on the duration of the public health emergency, while the economic consequences of the pandemic are likely to persist beyond the public health emergency period. The current increase in federal matching funds could offset or reduce state spending but is unlikely to fully offset state revenue declines and address budget shortfalls.

The election will have implications for LTSS issues, and Medicaids role as its primary payer, given the effects of the pandemic, the resulting economic crisis, and the coming age wave. Democratic Presidential nominee Joe Biden recently released a plan to increase access to Medicaid home and community-based services (HCBS), while the Trump Administration has proposed a Medicaid program-wide federal financing cap in the Presidents FY 2020 budget and is asking the Supreme Court to invalidate the entire Affordable Care Act, including provisions that allows states to expand Medicaid HCBS. This issue brief identifies trends in state policy actions related to Medicaid for seniors and people with disabilities and LTSS as of August 21, 2020. These include actions to expand eligibility and streamline enrollment, ease premium and/or cost-sharing requirements, enhance benefits, increase provider payment, modify provider qualifications, and alter reporting requirements.

States are adopting Medicaid policies targeted to seniors, people with disabilities, and LTSS in response to the pandemic through a variety of authorities that have different expiration dates. These authorities include Disaster-Relief State Plan Amendments (SPAs), traditional SPAs, other administrative authorities, HCBS waiver Appendix K, Section 1115 demonstration waivers, and Section 1135 waivers. The beginning and ending dates vary by authority (Appendix Table 1).

Fifteen states are expanding financial eligibility limits for seniors and people who qualify for Medicaid based on a disability to increase access to coverage during the public health emergency (Figure 2). Coverage groups where eligibility is based on old age or disability (known as non-MAGI groups) have income limits, and at state option, also may have asset limits. State actions to expand financial eligibility in these pathways include applying less restrictive income or asset methodologies and/or increasing HCBS waiver cost limits during the emergency period. For example, North Carolina is disregarding increases in assets for all non-MAGI groups until after the emergency period ends, and Massachusetts is allowing people with disabilities to obtain a temporary hardship waiver of the medically needy spend down requirement during the public health emergency. In addition, North Carolina and Washington are modifying financial eligibility criteria for some HCBS to cover beneficiaries who would otherwise not be eligible.

Less than half of states (23) are expanding functional eligibility criteria to help more people qualify for coverage based on a disability during the emergency period (Figure 2). In addition to meeting financial eligibility criteria, coverage groups related to disability status require individuals to meet functional criteria, for example, based on the extent of their self-care needs. Missouri expanded coverage to adults who test positive for coronavirus by considering it a qualifying disability for its aged/blind/disabled pathway. Indiana is giving HCBS waiver enrollment priority to people with COVID-19 or who are presumed positive from its waiting lists for waivers that provide non-residential supports for people with I/DD, while other states are temporarily modifying HCBS waiver functional eligibility targeting criteria. In addition, 13 states are modifying HCBS waiver assessment requirements to allow individuals to begin receiving services before a functional eligibility evaluation is completed (no data shown).

Maryland and Utah are increasing the total number of individuals served in HCBS waivers during the emergency period (Figure 2). Maryland is increasing the number of individuals served in its waiver for children with autism spectrum disorder; Utah is increasing the number of individuals served by a waiver for people transitioning from institutions to the community. Unlike state plan coverage groups, states can limit the number of people who enroll in waivers, which can result in waiting lists when the number of people seeking services exceeds the number of waiver slots available. States acknowledged that the pandemic may exacerbate the need for HCBS waiver services; for example, Pennsylvania noted that many people on its waiver waiting list have aging caregivers who may not be able to continue providing care if they develop COVID-19. However, few states have been able to increase the number of waiver enrollees served in response to the pandemic. In addition, 16 states are allowing individuals to maintain HCBS waiver eligibility without receiving services, which can keep enrollees connected to coverage while services are interrupted due to provider shortages or restrictions due to state stay-at-home orders or while individuals are receiving inpatient treatment during the pandemic (Figure 2).

Nearly all states are taking at least one action to streamline eligibility determinations to expedite enrollment in coverage for seniors and people with disabilities during the emergency. Eleven states are allowing hospitals to make presumptive eligibility determinations for non-MAGI groups during the emergency, which can help connect people to coverage at the time they seek medical treatment (Figure 2). Seven states are allowing applicants in non-MAGI pathways to self-attest to financial and/or functional eligibility requirements in lieu of requiring documentation before determining eligibility (Figure 2). The most frequent action in this area is permitting virtual evaluations to determine HCBS waiver functional eligibility and/or otherwise modifying processes for HCBS waiver level of care evaluations and reevaluations to account for social distancing during the pandemic, adopted by 50 states (Figure 2).

Almost all states are extending eligibility renewal due dates during the pandemic to keep people connected to coverage and enable states to focus limited state agency staff time on responding to the emergency. Forty-nine states are extending reassessment and reevaluation due dates for one or more HCBS waivers (Figure 2). Pennsylvania is extending eligibility renewal deadlines for non-MAGI populations to every 12 months. As one of the conditions of receiving the enhanced federal matching funds under the Families First Coronavirus Response Act, states must provide continuous eligibility for individuals enrolled on or after March 18, 2020 through the end of the month in which the public health emergency ends.

States are eliminating or easing premiums and cost-sharing requirements to help seniors and people with disabilities remain in coverage and facilitate access to services during the pandemic. More than one-third of states are eliminating or waiving premiums in Medicaid pathways that offer buy-in coverage for working people with disabilities, while a couple of states are easing cost-sharing requirements (Figure 1). Connecticut is suspending copayments for individuals who are dually eligible for Medicare and Medicaid. Rhode Island has adopted a policy that helps ensure that people with short-term nursing home stays will have a community-based residence to which they can return post-discharge by allowing enrollees to receive a home maintenance allowance throughout the public health emergency. This policy accounts for the financial cost of maintaining a home in the community by reducing the amount that these enrollees must pay out-of-pocket for institutional care and applies to individuals who were institutionalized for less than six months as of March 1, 2020, and unable to be discharged home due to COVID-19.

About half of states (27) are temporarily adding new services to their regular LTSS benefit packages to meet enrollee needs during the public health emergency (Figure 3). Nearly all state actions in this area relate to expanding the benefit packages available under HCBS waivers and/or Section 1915 (i) state plan HCBS. Frequently added services include home-delivered meals; medical supplies, equipment, and appliances; and assistive technology. Some states are adding other services to address the emergency. For example, Washington is adding wellness education to help HCBS waiver enrollees manage chronic conditions, avoid health risks and be informed about COVID-19. Indiana is adding rent and food reimbursement to help enrollees in an I/DD waiver offset the costs of room and board for an unrelated, live-in caregiver during the emergency. On the institutional LTSS side, Ohio has created a new benefit, Health Care Isolation Centers. These services are provided in specialized COVID-19 facilities to individuals who have been discharged from hospitals but continue to need medical and isolation care that cannot be provided in the community or their former congregate setting.

While the majority of benefits changes are expansions, one state is restricting benefits, and many are restricting visitors in HCBS settings in efforts to contain coronavirus spread (no data shown). Washington has authority to suspend specialized add-on nursing home services like habilitation during an emergency to protect the health of residents and staff. Similar to CMS guidance restricting visitors in nursing homes, 40 states are not allowing any visitors in at least some HCBS waiver residential settings to minimize the spread of infection.

Most states (43) are temporarily modifying utilization limits for covered services to ensure that enrollees can access services and address health and welfare issues during the emergency (Figure 3). Among these states, most are allowing utilization limits to be exceeded for HCBS waiver and/or state plan services. For example, Arkansas is removing its limit on physician visits in nursing homes, and Ohio is lifting hour and day limits on private duty nursing services post-discharge. In addition, 31 states are temporarily modifying the scope of HCBS waiver covered services to account for needs created by the pandemic (no data shown). For example, Tennessee is adding HCBS waiver services to support individuals with I/DD with shopping, hygiene, meal preparation and money management. By contrast, North Carolina, Rhode Island and Washington are restricting utilization of HCBS services (no data shown). All three states have Section 1115 waivers that allow them to vary the amount, duration, and scope of services based on population needs. In addition, North Carolina and Washington may target services on a less than statewide basis.

Most states (41) are suspending prior authorization requirements to ensure access to HCBS waiver and/or state plan services during the emergency (Figure 3). For example, Connecticut is waiving prior authorization for home health services, Maryland is suspending prior authorization for remote patient monitoring, and Nebraska is waiving prior authorization for transfers to post-acute long-term acute care hospitals, acute inpatient rehabilitation, or skilled nursing facility care. In addition, eight states are allowing other licensed providers to order home health services for state plan HCBS in addition to physicians (no data shown).

Nearly all states are expanding the settings where enrollees can receive HCBS to account for disruptions due to COVID-19 (Figure 3). Among these states, 49 are temporarily expanding the settings where HCBS waiver services can be provided during the public health emergency to include providing services in hotels, shelters, schools and churches, as needed. In addition, 35 states are allowing individuals in short-term inpatient settings to receive HCBS to provide communication and behavioral supports (Figure 3). Most states have adopted this policy for one or more HCBS waivers, and a couple are doing so for state plan HCBS: Alaska is allowing Community First Choice attendant care services to be provided in acute care hospitals, and Oregon is temporarily allowing payment for state plan HCBS, including home-based habilitation, behavioral habilitation, and psychosocial rehabilitation services, to individuals in an inpatient setting.

Nearly all states (50) are modifying care-planning processes to accommodate social distancing and facilitate access to services during the emergency (Figure 3). Examples of frequently adopted policy changes in this area include modifying the person-centered plan development process for HCBS waiver services, adjusting functional assessment requirements used to determine service levels, and adding electronic document signing. Other policy changes in this area include allowing verbal consent instead of a written signature for HCBS service plans and allowing the face-to-face encounter for home health services to take place up to one year after an individual begins receiving services. North Carolina and Washington are allowing for the provision of LTSS to individuals impacted by the emergency even if the services are not updated timely in the care plan. Michigan is extending service authorizations in person-centered service plans for state plan HCBS throughout the duration of the public health emergency.

Nearly all states have expanded the delivery of HCBS via telehealth (Figure 3). Forty-seven states are adding electronic service delivery methods to continue providing HCBS waiver and state plan in-home services remotely. Minnesota is allowing state plan group therapy and rehabilitative services to be provided via telehealth. Oregon is allowing adding telehealth delivery of state plan home-based habilitation, behavioral habilitation, and psychosocial rehabilitation services. Connecticut is allowing for telephonic check-ins in lieu of face-to-face assistance for certain mental health HCBS waiver enrollees. DC is also covering services provided remotely to state plan HCBS recipients, such as wellness checks and therapeutic activities.

Just over half of states are increasing institutional LTSS payment rates (Figure 4). Among these 26 states, 24 have increased rates for nursing homes, which have been disproportionately affected by the COVID-19 pandemic, and five states are doing so for intermediate care facilities for people with intellectual or developmental disabilities or other institutional settings (no data shown). Most states are implementing per diem or percentage rate increases, while a few states are increasing the number of days for which facilities can receive bed hold payments to account for absences due to COVID-19 treatment. Alabama also is providing an additional add-on cleaning fee. Kentucky is temporarily pausing per diem rate sanctions to nursing facilities that are unable to meet medical record review thresholds to validate assignment of patients to reimbursement groups based on acuity during the public health emergency.

Some states limit the additional payments to facilities or patients with a COVID-19 diagnosis, while others apply them to all nursing facilities to account for increased costs related to staffing, equipment and cleaning as a result of the emergency (no data shown). For example, Michigan is providing a $5,000 per bed supplemental payment in the first month for COVID-19 regional hub nursing facilities to address immediate infrastructure and staffing needs and a $200 per diem rate increase in subsequent months to account for the higher costs of caring for COVID-19 patients.

A couple of states specifically have included pay increases for direct care workers in nursing homes and/or other institutional settings (no data shown). Arkansas adopted temporary supplemental payments that increase direct care workers weekly pay by a base supplemental payment according to number of hours worked and an additional tiered acuity payment for those working in facilities with COVID-19 positive patients. Texas nursing facility payment rates increase includes a pay increase for direct care workers and an increase for supply and dietary costs.

Just over two-thirds of states (35) are increasing provider payment rates for at least some HCBS state plan or waiver services during the public health emergency (Figure 4). For example, Alabama is increasing waiver payment rates for personal care, adult companion, respite, and skilled nursing care to account for overtime pay, staffing needs and infection control supplies. Louisiana has received approval to increase payments for all services provided under its Community Choices Waiver for elderly and disabled adults by up to 50% as needed to maintain staffing. States increasing payment rates for HCBS provided under state plan authority include targeted case management (AK), day habilitation (AR), skilled and/or private duty nursing (DC, OK), and home health and adult care homes (NC). Arkansass temporary supplemental payments for direct care workers in nursing facilities also apply to direct care workers in assisted living facilities and those providing home health and personal care services in the community. Michigan adopted a supplemental payment for providers of personal care and behavioral health treatment technician in-person services. Washingtons Section 1115 demonstration waiver allows the state to increase rates for Community First Choice attendant care services by up to 50 percent to maintain provider capacity during the public health emergency. In addition, Tennessee has adopted temporary payment rate increases for community-based residential, personal care, attendant care, personal assistance and intensive behavioral treatment stabilization and treatment services and a temporary per diem add-on to community-based residential and personal care payment rates to account for direct support staff hazard pay, overtime, and PPE costs using its existing directed payment authority; these services are provided under a Section 1115 HCBS waiver.

Among the states adopting LTSS provider payment increases, 18 states have increased rates for both institutional and community-based services (no data shown). Ten states have increased provider payments for only institutional services, while 17 states have increased rates for HCBS only.

About three-quarters of states are adopting retainer payments for HCBS providers (Figure 4). Thirty-eight states have adopted retainer payments for providers offering HCBS through waiver and/or state plan authorities. For example, Washington and New Hampshire have an approved Section 1115 waiver that authorizes retainer payments for personal care and habilitation services provided under state plan authority.

Two states are making interim payments to LTSS providers (Figure 4). Among these states, North Carolina allows any Medicaid-enrolled provider to request that their reimbursement be converted to an interim payment methodology, while Georgia is making interim payments to skilled nursing facilities.

Nearly all states (50) are temporarily modifying HCBS state plan and/or waiver provider qualifications in response to potential staff shortages and increased demand due to COVID-19 (Figure 4). Frequently adopted policies in this area include temporarily permitting payment for HCBS waiver services rendered by family caregivers or other legally responsible relatives during the emergency (if not already permitted in the waiver), adopted by 38 states (no data shown). Twenty-three states are waiving conflict of interest rules and allowing case management entities to also be direct service providers for HCBS waiver enrollees during the emergency (no data shown). In addition, all states have adopted modified provider screening requirements through Section 1135 waiver authority, which may apply to LTSS providers as well as other providers.

Few states are adopting reporting requirements for COVID-19 cases and deaths among HCBS enrollees (Figure 4). CMS is requiring all nursing facilities to report COVID-19 cases and deaths as of May 8, 2020, but just nine states are requiring reporting of COVID-19 cases among HCBS waiver enrollees. HCBS waiver enrollees living in congregate settings such as group homes are likely to experience increased risk from coronavirus infection similar to individuals in nursing homes. In addition to the CMS nursing home reporting requirements, three states (AZ, CT, IN) have adopted their own reporting requirements related to COVID-19 cases and deaths for long-term care facilities. For example, Connecticut requires managed residential communities and nursing homes to provide daily COVID-19 status reports. Arizona also requires reporting on COVID-19 cases and deaths from group homes.

Twenty-nine states are temporarily modifying HCBS waiver incident reporting requirements and other participant safeguards during the public health emergency (Figure 4). This allows states to focus their administrative efforts on the COVID-19 response. However, there are potential risks for enrollees as incident reporting is a requirement for HCBS programs to protect enrollees from abuse, neglect and injury and to ensure their health and safety. Twenty-eight states are delaying submitting HCBS waiver enrollment and spending reports to CMS and/or are suspending data collection for performance measures other than health and welfare (no data shown). In addition, forty-seven states are suspending pre-admission screening and annual resident review requirements for nursing facilities (no data shown).

The duration of the public health emergency has implications for policy actions adopted under Medicaid emergency authorities as well as the availability of enhanced federal funding provided through the match rate increase. Many state policy changes have been adopted through temporary authorities that will expire after the public health emergency declaration ends, which will lead policymakers to assess whether any policies can or should be retained and transitioned to other authorities. In addition, some policy changes in response to the pandemic may be difficult for states to sustain without additional federal financial support beyond the 6.2 percentage point increase in federal Medicaid matching funds authorized by Congress during the public health emergency, as states are facing revenue declines and budget shortfalls.

A great deal of attention has been focused on the impact of COVID-19 in nursing homes, given the disproportionate number of cases and deaths among residents and staff nationally with less attention on community-based residential settings. The Trump Administration has issued guidance about how nursing homes should respond to the pandemic, announced the formation of an independent commission to assess nursing home response, and adopted new reporting requirements for COVID-19 cases and deaths in nursing homes. To date, less attention to COVID-19 cases and deaths generally has been paid to community-based residential settings, such as group homes, where the pandemic presents similar risks to Medicaid enrollees and providers due to the highly transmissible nature of the coronavirus, the congregate nature of the setting, and the close contact that many workers have with residents. Data about COVID-19 cases and deaths in both institutional and community-based congregate settings may allow policymakers to more fully assess the impact across populations at increased risk of adverse health outcomes. The pandemic also may exacerbate the need for HCBS waiver services, which already are subject to waiting lists in a number of states. For example, elderly parents sickened by COVID-19 may no longer be able to provide care for their adult children with disabilities. Beyond the pandemic, the coming age wave makes LTSS and Medicaids role as the primary payer likely to be policy issues faced by the next Administration, in addition to the continuing effects of the pandemic and economic crisis.

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State Actions to Sustain Medicaid Long-Term Services and Supports During COVID-19 - Kaiser Family Foundation

Brainstorming.com has launched a new collaborative ideation platform intended to help people share and upgrade each others ideas. Each of us has strengths and weaknesses. combined however, there is synergy and there is great intellectual power. The platforms goal is to bring together communities of creative individuals and help focus their collective intelligence on specific problems.

The launch of the platform seems to be a natural evolution for the company aiming to advance the frontiers of science and making our technologies catch up with our ambitions.

Companys founder, Darko Savic, explained that the platform matches people by field of interest rather than expertise, helps them bridge the different paradigms, and keeps the destructive human behaviors like trolling, bullying, posting nonsense, at bay. Different minds look at problems from different perspectives. What may be obvious to one person, can spark a revelation in another brain that is wired just a little differently. The focus is on having the thought process move from mini-breakthrough to breakthrough. This should result in productive collaboration between people who tolerate each others shortcomings and build upon each others ideas.

He further elaborates that everything humanity has ever created has been accomplished on the shoulders of others. Its how people achieve progress. The brainstorming platform turns this into a focused idea iteration process.

Just as Youtube is a general-purpose video sharing platform, Brainstorming.com is a general-purpose brainstorming platform where people share and upgrade each others ideas. Within the sea of random videos, there are some concerted efforts to do good for the world. A Youtube example of such an effort is the Team Trees campaign where people came together to combat climate change. Analogous to this, is how Brainstormings Longevity team intends to use the Brainstorming platform to advance ideas in the field of human life extension.

Initially, they are starting with a narrow focus audience interested in the science of biological longevity. They expect that with time, as the user base grows, the topics would organically diversify and encompass whatever people want to brainstorm about. They plan on establishing dedicated focus teams for each of the humanity impacting fields like artificial intelligence, climate preservation, bioengineering, space travel, entrepreneurship and others.

Read more from the original source:
Brainstorming.com Launches a New Collaborative Idea Building Platform - London Daily Post

Global Precision Medicine Software Market analysis 2020 covers the entire supply chain, focusing on supply, demand, trade and prices by country and product. Precision Medicine Software market is expected to keep experiencing a greater level of competition with a growing number of players focusing on securing a larger market share. It incorporates thorough business profiles of some of the prime vendors in the market. The report includes vast data relating to the recent discovery and technological expansions perceived in the market, wide-ranging with an examination of the impact of these intrusions on the markets future development.

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Under the COVID-19 outbreak globally, this report includes a detailed and comprehensive overview of the competitive landscape and the administrative structure of the Global Precision Medicine Software Market. In this way, users gain an adequate understanding of the condition of drivers, restrictions, opportunities and strategies that affect the market. The report also includes both subjective and objective analyzes of the global market.

Companies considered and profiled in this market study: Syapse Inc. (US), 2bPrecise LLC (Israel), Foundation Medicine Inc. (US), Fabric Genomics (US), SOPHiA GENETICS SA (Switzerland), PierianDx Inc. (US), N-of-One Inc. (US), Human Longevity Inc. (US), Translational Software Inc. (US), Sunquest Information Systems Inc. (US), Gene42 Inc. (Canada), LifeOmic Health LLC (US), NantHealth Inc. (US), Tempus Labs Inc. (US), Flatiron Health Inc. (US), IBM Watson Group (US), and Koninklijke Philips N.V. (Netherlands) etc.,

North America, Europe, the Asia Pacific region, the Middle East and Africa as well as Latin America are the most important regional markets. However, it is now also to be expected that some other regions will take the lead in the next few years and prove to be the most promising regional markets. The global Precision Medicine Software Market is also expected to grow rapidly in the near future due to the presence of a large number of people entering this market sector.

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Thus, a complete study of the competitive landscape of the Global Precision Medicine Software Market has been given, presenting insights into the company profiles, financial status, recent developments, mergers and acquisitions, and the SWOT analysis. This study also provides an in-depth analysis of the global market with future estimates to identify current trends and investment trends for the forecast year 2020-2027.

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