DISASTER RELIEF/LEGAL SERVICES: Hurricane Sandy disaster relief legislation signed Jan. 29 by President Obama includes $1 million for the Legal Services Corporation (LSC) to provide legal assistance to low-income individuals affected by the storm, which hit the East Coast in late October. The funds provided to the LSC by P.L. 113-2 (H.R. 152) will be used for mobile resources, technology and disaster coordinators to provide storm-related services to LSC’s client population in the areas significantly damaged by the storm. “Legal issues caused by natural disasters often disproportionately affect low-income families, seniors, veterans and others who are least able to deal with them,” LSC President James J. Sandman explained following the signing of the bill. During debate on H.R. 152, the House defeated, by a 202-217 vote, an amendment proposed by Rep. Jeff Duncan (R-S.C.) to remove the LSC funding from the bill. Supporters of the additional LSC funding argued that legal aid offices in Sandy-affected areas are experiencing a huge increase in requests for civil legal assistance that is directly related to the storm and its aftermath. Rep. Nita Lowey (D-N.Y.), pointed out that legal aid programs in New York and New Jersey set up recovery hotlines, staffed FEMA disaster recovery centers, and provided legal counseling through clinics. Local legal services program also helped families obtain emergency food stamps, disaster-related unemployment insurance benefits, and Federal Emergency Management Agency benefits to pay rent and other expenses, she said.

 

ELECTRONIC HEALTH RECORDS: The ABA recently commended the Health Information Technology Policy Committee for including elements that have the potential of supporting advance care planning efforts in two recent draft recommendations for meaningful use of electronic health records (EHR). The association also suggested in comments submitted to the committee Jan. 11, however, that another recommendation regarding advance directives be replaced with more robust and relevant criteria. The draft recommendations relate to Stage 3 (improved outcomes), the third stage of development of standards and certification criteria for electronic health records to the purposes of Medicare and Medicaid EHR incentive programs. The Department of Health and Human Services has already announced final rules for Stage 1 (data capture and sharing) and Stage 2 (advance clinical processes). In the comments, ABA Governmental Affairs Director Thomas M. Susman expressed ABA support for SGRP 204B, which would add a new menu item for including patient-generated health information, such as advance directives, in the record, and SGRP 304, which seeks to ensure that, in the future, care plan information is communicated in transition across care settings. Susman wrote that SGRP 112, however, would require the recording of whether a patient 65 or older has an advance directive but does not call for inclusion of the actual content of the advance directive. According to Susman, the proposal would provide “little in the way of useful data and may even do harm in light of research that shows that a significant proportion of providers make erroneous assumptions about the wishes of patients when told of the existence of a directive without details of its contents.”  The ABA, he said, recommends several steps to improve SGRP 112, including requiring that documentation in the record include a copy of the patient’s advance directive or advance care planning notes, or a copy of a Physician Orders for Life Sustaining Treatment (POLST) form. He also noted the ABA’s longstanding history of policy supporting the use and recognition of advance care planning tools. In addition, the ABA supports strengthening federal law to give patients an opportunity to discuss advance care planning with health care providers after admission and as part of annual Medicare wellness exams.

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