US Court of Appeals Decision Pushes EPA to Update Standards on Lead Paint in 90 Days

On December 27, 2017, the United States Court of Appeals for the Ninth Circuit issued a decision requiring the Environmental Protection Agency to propose updates to its 17-year-old standards for lead-based paint and dust within 90 days. Previously, the EPA had requested an additional six years to reconsider what level of lead exposure is acceptable for children, but the overwhelming scientific acknowledgement that lead-based paint hazards cause serious health effects to our nation’s children requires the Agency to act swiftly now. 
The Ninth Circuit determined that the EPA has a responsibility to conduct an ongoing review of its initial standards and to modify its lead-based paint standards to make sure they are adequately protective of children’s health. This decision recognizes both the toxic legacy of lead and the continued risk posed by lead-based paint hazards which persist in millions of homes nationwide. GHHI strongly supports the Ninth Circuit’s decision as a step toward modernizing our standards and strategies in light of current science and best prevention practices. We also want to recognize the Court for the potential impact that this decision may have in preventing lead poisoning and brain damage for thousands of vulnerable children each year.
GHHI’s Strategic Plan to End Childhood Lead Poisoning – A Blueprint for Action documents specific, evidence-based, actionable strategies to end childhood lead poisoning in five years. The Plan recommends updated federal guidelines and standards for inspections, lead dust testing and clearance, reflecting current scientific and technical knowledge. As the convener of the National Campaign to End Lead Poisoning, GHHI, in partnership with organizations around the country, is leading the charge to eliminate childhood lead poisoning in the United States. We look forward to continuing to work with partners to advance this important work, and support the nation’s children in achieving their full potential.
Read the Ninth Circuit’s opinion in this case at:

City of Memphis Joins GHHI Network

Green & Healthy Homes Initiative (GHHI) is excited to welcome the City of Memphis into their network of cities, counties, and states who are taking proactive measures to ensure healthy housing is made available to families and children living in underserved communities.
“Safe and healthy housing is a building block that too many of us take for granted and too many others struggle to achieve," said Memphis Mayor Jim Strickland. “Thank you, not only as mayor of the city of Memphis, but I want to thank all the partners... for stepping up and helping these young people. I'm so proud to be a member of this partnership and I look forward to great outcomes.”
City of Memphis Director of Housing and Community Development, Paul Young; and President of Le Boneheur Children's Hospital, Meri Armour also spoke to the significant value of joining the GHHI family, which will be instrumental in strengthening the city’s goal to break the link between unhealthy housing and unhealthy children.
GHHI strives to provide every child, family and senior with access to an affordable, healthy home. The signing of this proclamation further highlights the city’s steadfast and committed approach to addressing this goal and the needs of low-income residents on matters concerning their health.
“We are beginning today, real work for real results for kids who will never know our names, but who will get to a classroom and will learn better and compete better, and will put Memphis even greater on the rise,” said President and CEO of Green & Healthy Homes Initiative, Ruth Ann Norton. “This vision is about where we will be five years from now for the 35% of the community that has hazards in their home.”
In September, the city also hosted GHHI for their annual conference providing the team with a firsthand opportunity of their work-to-date and the latest improvements to homes.
GHHI is inspired by the commitment of the city and county leaders; and the civic and nonprofit leaders giving us confidence in Memphis’ ability to achieve its vision as a national leader in healthy, safe and energy efficient homes. Now the real work of implementation begins!

Potential Lead Risks in Fidget Spinners

A recently released report in the by the US Public Interest Research Group (US PIRG) has revealed that at least some commerically popular fidget spinners contain high levels of lead.
Specifically, the Fidget Wild Premium Spinner Brass has tested at 33,000 parts per million (ppm) for lead. The allowable parts ppm for children's toys is only 100 ppm, making these fidget spinners over 300 times the allowable limit.
So how are they staying on the shelf? Target, the store carrying them, as well as the manufacturer are arguing that these toys are intended only for those ages 14 and up, making them not children's toys but "general use products."
This is absurd on its face. Fidget spinners are clearly marketed towards and used by children, as anyone who has spent time around children recently can attest. And even if they weren't, leaving lead contaminated items on the shelf inherantly runs the risk of them being picked up or played with by a child, making them potentially dangerous.
The Consumer Product Safety Commission (CPSC) should reclassify fidget spinners as toys, not general use products. And whether or not this action takes place, these toys should be removed from the shelves as soon as possible to protect the safety of children.

National Fall Prevention Day

Falls are the leading cause of injuries and deaths among older adults.  According to the Center for Disease Control (CDC), in 2014 there were 29 million reported falls among older Americans resulting in about 31 billion dollars in annual Medicare costs. What makes these numbers shocking is not simply the fear for older adult safety but how simple it can be to reduce their slip, trip and fall hazards to ensure their safety.
Simple education can prove to go a long way in helping older adults move around safely in their home all while maintaining their independence. At the Green & Healthy Homes Initiative (GHHI) we provide a holistic approach to help our clients reduce fall risks in their home. GHHI goes beyond providing the simple, yet important, older adult safety measures (handrails, grab bars, lighting etc.) and provides education to the client to assist in maintaining to senior home modifications. The GHHI model addresses the physical and nutritional adjustments that are proven by the National Institute of Aging to improve mobility as well as promote the importance of doctor-patient communication, medication management and adherence, and housing stability for homeowners. This multifaceted approach not only addresses the need of older adult homeowners in the Baltimore City area, but it also retains independence and provides our clients with a level of confidence that allows them to age gracefully and fall-free with their homes.
Why is fall prevention important? Well statistically more than 40% of hip fracture patients do not return home or are unable to live independently once they are released from the hospital. Going from independence to dependency can have major effects on an individual’s mental and social health. Impacts on mental and social health can exacerbate existing conditions by increasing stress and decreasing medication compliance; even putting the individual at risk for another fall. With age the risk for breaking or fracturing a bone increases and that risk is higher among women than in men. The good news is that most falls can be prevented with inclusive, informative and credible education, physical activity, medication management and environment modifications. Let’s begin fall with fewer falls!
Have a happy and fall free FALL!
Jalecia Tucker
Aging in Place Case Manager, Green & Healthy Initiative

Recognizing the Need for Medicaid Reform

Recommendations for Reforming Medicaid from JAMA Forum article which can be located at
Medicaid program was originally passed by Congress in 1965 and now serves more than 70 million people in 4 categories: children and mothers, seniors in nursing homes and community-based settings, people living with disabilities, and low-income people of all ages. As much as 70% of the program’s resources are devoted to people who have disabilities or live in nursing homes. However, most Medicaid beneficiaries are children and mothers and, after passage of the ACA, low-income adults and families. A state-federal partnership, Medicaid policies are driven at the state level through waivers and State Plan Amendments submitted to the federal government.
Policy Recommendations for Reforming Medicaid

Making Medicaid a more outcomes-based program. Metrics such as the early diagnosis of illness, incidence of low-birth-weight infants, maternal mortality, and the efficiency of care delivered could form the basis of such measures. 

Improving Medicaid financing. Too much funding comes from large supplemental pools (such as Medicaid disproportionate share hospital [DSH] payments and uncompensated care pools) that go to states. These pools decrease accountability because they are allocated without regard to patient care or even the numbers of people treated. Finally, we support financing strategies that would encourage investments in the social determinants of health, which are the cause of so many health disparities and undesirable outcomes.

Ensuring proper access to care.  Nationally there is appropriate concern about access to specialists and home-based and community-based services, which varies broadly by state and is of concern in rural areas and where reimbursement rates are too low. Eliminating nonaccountable pools of funding would allow states to improve their reimbursement rates to specialists and help to expand access.

Investing in a data, technology, and analytics infrastructure. For Medicaid to deliver on its potential, the program needs to use best practices in home-based and community-based care and other programs that use social workers, home care attendants, and other resources to keep families together, coordinate care, and allow people to be treated in the most comfortable, cost-efficient settings

Coordinating programs for dual-eligible beneficiaries (who qualify for both Medicaid and Medicare) and other populations. There are growing, expensive populations that do not fully benefit from investments in care coordination commonly used in the private sector.

Reducing administrative burden on states and allowing for more rapid innovation. Medicaid is a highly flexible program, with a variety of different approaches designed to serve the frail elderly, provide substance abuse treatment, create innovative payment approaches, and capitalize on mobile technology. We support the ability of states to innovate more rapidly through thoughtful reform of the waiver process and the process of submitting State Plan Amendments

GHHI’s Push for Medicaid Policy Change
After reading the JAMA Forum article summarized above it occurred to us that GHHI has been actively working to achieve these Medicaid reform recommendations from its inception. From the outset GHHI has set as one of its organizational goals to change policies within states and at the federal level to allow for Medicaid payments to reimburse for the provision of in-home environmental management services.
Along the way GHHI has learned to achieve the vision of reimbursement for comprehensive environmental management services, which combine both in-home environmental health education, comprehensive environmental assessment and remediation of triggers, requires a collective impact approach. The Collective Impact approach is premised on the belief that no single policy, government department, organization or program can tackle or solve the increasingly complex social problems that are underlying factors. The approach calls for multiple organizations or entities from housing, education, energy and health sectors, to form a common agenda, shared measurement and alignment of effort.
Our recent Pay For Success grants activities, funded by Corporation for National and Community Services the JPB Foundation, and the Robert Wood Johnson Foundation, has focused on providing business development support for asthma programs in eleven cities across the country.  Through these ongoing projects and future collaborations we are working to increase the number of in-home asthma programs that target “high utilizers” in low-income communities, and ensure they all provide comprehensive indoor environmental management services to reduce asthma triggers which are eligible for Medicaid reimbursement.
GHHI’s National Asthma Campaign Aligns with Expert Recommendations to Reform Medicaid

Making Medicaid a more outcomes-based program. GHHI is working to establish Environmental Management & Health Outcomes Metrics for Evaluation (EMHOME) which will include environmental management measures (housing characteristics, hazards identified, services provided) and outcome metrics (asthma control, quality of life, healthcare utilization and costs) to demonstrate efficacy and return on investment. 

Improving Medicaid financing. GHHI has explored numerous alternative payment methods that could allow for reimbursement including 1115 waivers, value-based payments, bundled payments, administrative billing as well as incorporating private capital through pay for success.

Ensuring proper access to care.  Medicaid service delivery reform has the potential to protect vulnerable populations with asthma by establishing effective state policies which incentivize coordination of services among traditional and non-medical providers. Use of community health workers can improve access to asthma care management services within the home.

Investing in a data, technology, and analytics infrastructure. Cost benefit analysis that relies on actuarial analysis of Medicaid claims data is key to identify the target populations and potential return on investment. Secure data sharing between sectors is necessary to identify, recruit and coordinate clinical and home-based services to “high utilizers” within asthmatic populations.

Reducing administrative burden on states and allowing for more rapid innovation. Strategic partnerships between MCOs/ACOs and service providers that facilitate innovative payment structures, such as value-based payments, can drive policy change at the state‘s direction without increasing administrative burden on states.

Coordinating programs for dual-eligible beneficiaries (who qualify for both Medicaid and Medicare) and other populations. GHHI has not directly worked on this recommendation but sees the value especially related to home interventions to prevent falls in older adults.



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