Dr. Bob
Well-Known Member
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
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
