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Have you contacted your U.S. Representative and asked him/her to cosponsor H.R. 3995? If yes, have you followed-up? Contact Tamie with any questions and to receive H.R. 3995 advocacy materials (605-399-1624; tamie327@hotmail.com) --------------------------------------- ======================================================== 1. Mark your Calendar! Join VOR in Washington, D.C. this June! FEDERAL NEWS 2. Congress Passes Omnibus Bill ========================================================
---------------------------------------------------------------------------------- VOR will be hosting its 2008 Annual Meeting and Washington Initiative this June 2008. All VOR events will again take place at the Holiday Inn on the Hill. Very soon I will distribute an official flyer and registration form. Meanwhile, here are the important dates: Friday, June 13, 2008: Annual VOR Board of Directors Meeting
(afternoon) Exciting Anniversary Event for 2008 2008 marks VOR’s 25th Anniversary. VOR will host a special reception and dinner for VOR members on Saturday evening, June 14, to celebrate VOR’s 25th Anniversary. The event will be hosted at the historic landmark, The Monocle, just off Capitol Hill! VOR needs your help identifying and soliciting sponsorships for this important event. Each year, the participation and financial support for this critical VOR event has grown. I hope and expect that 2008 will be no different. With your help, we can reach new heights! If you need a sponsorship flyer to share with a potential individual, organization or corporate sponsor, visit http://vor.net/2008Sponsorship.htm or contact Tamie – 605-399-1624; Tamie327@hotmail.com. (See who sponsored in 2007: http://vor.net/2007sponsors.htm) Annual Meeting Overview, Saturday, June 14, 2008 The agenda for the Annual Meeting is already taking shape. Here’s an overview of the agenda: 1. A panel discussion on the Individual Planning Process (IPP): This panel will focus on the legal (regulatory) requirements regarding the IPP process and how families can be effective advocates for their loved ones during this annual planning process. Panelists are Dianne Smith, CMS Technical Director and Team Leader for ICF/MR; Robin Sims, VOR’s First Vice President; and Kathleen Miller, a social worker for Sonoma Developmental Center, where her son is also a resident. 2. A disability policy expert from Capitol Hill (tentatively confirmed) 3. Coalition Building, by Sonya Mawhorter, Executive Director, Ohio League for the Mentally Retarded (OLMR). Washington Initiative Overview It is anticipated that our priority issue will be H.R. 3995. The DD Act Reauthorization may also be a critical issue for our Initiative, depending on when it is introduced (timing is yet unknown). 2nd Annual Capitol Hill Reception VOR will again host the very popular Capitol Hill Reception during the week of June 16. More details will be forthcoming. ======================================================== FEDERAL NEWS ----------------------------------------- Summary: I am still trying to determine the funding totals for the DD Act program for FY 2008 (such as P&A, DD Councils and University programs). These programs would have received funding as part of the Labor HHS Education section of the Omnibus bill, as noted below. Source: APHSA, Working for Tomorrow, December 2007 On December 19, the House approved the omnibus fiscal year 2008 appropriations bill, H.R. 2764, by a vote of 272 to 142. The Senate had approved the $555 billion bill earlier, and the president signed it on December 26. The legislation covers the 11 annual appropriations spending bills that had not yet been passed, including Labor, Health and Human Services (HHS) and Education. The measure includes a $3.7 billion increase in veterans’ programs and another $7.4 billion in “emergency spending,” mostly for programs the administration supports. The final Labor-HHS spending amounts total $145.1 billion in discretionary spending and $307 million in “emergency” funds. The discretionary amount includes a 1.747 percent across-the-board reduction for all programs in this section of the bill. In Access to Health Care Initiatives, the omnibus bill included one new line item as part of efforts to increase access to health care for the uninsured. Congress approved $49 million to help states in providing high-risk insurance pools. In Rural Health Programs, the bill restored and increased funding for rural health programs that were eliminated or significantly cut in the president’s budget request. In the Community Health Centers line item, the bill includes increases that are above the increase included in the President’s budget proposal. ----------------------------------------------------------------------------- 3. CMS Publishes Interim Final Rule on Targeted Case
Management Source: APHSA, Working for Tomorrow, December 2007 On December 4, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule that affects Medicaid reimbursement for case management and targeted case management (TCM). CMS estimates that the change will reduce federal Medicaid expenditures by almost $1.3 billion over five years. States would no longer receive Medicaid reimbursement for case management services that could be paid for by third parties or other federal programs. The regulation implements section 6052 of the Deficit Reduction Act of 2005. Among the activities excluded from the definition of TCM are transportation services, day care services and administrative activities for foster care or other non-medical programs. The rule also restricts Medicaid coverage for case management for institutional transitioning from 180 days to 60 days, for any resident who has been living in a facility for more than 6 months. If the individual has been in the facility for less than 6 months, then Medicaid coverage for case management is restricted to just 30 days. VOR note: This rule has outraged some advocates who argue that 60 days is not enough to ensure that all service components and resources, including housing, staffing, transportation, etc., are in place before someone is moved.
------------------------------------------------------------------------- Source: APHSA, Working for Tomorrow, December 2007 The National Governors Association (NGA) and the National Association of State Budget Officers released their 2007 Fiscal Report on the States on December 5. The analysis shows an estimated increased rate in growth of Medicaid budgets from 1.7 percent in 2006 to 7.3 percent in 2007, based on the National Association of State Budget Officers’ 2006 State Expenditure Report. The lower rate of growth in 2006 is partially due to the changes in financing of prescription drug benefits for dual eligible individuals (Medicare part D). According to the report, Medicaid accounts for 22 percent of state budgets, with all healthcare accounting for a third of the state budget. This is the largest portion of state spending. States are facing other challenges as well, including health care cost increases, access for the uninsured, and increased demand for services. ---------------------------------------------------------------------------------- 5. Update on Medicaid Programs and the States: Fall NASMD
Meeting Highlights Medicaid Developments and Innovations The 2007 Fall National Association of State Medicaid Directors (NASMD) Meeting was held in Washington, DC on November 12-15. There were more than 700 attendees, with 48 state Medicaid Directors and four Territories Directors in attendance. Among the featured Plenary speakers were U.S. Department of Health and Human Services Secretary Michael Leavitt; Kerry Weems, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS); and Dennis Smith, Director of the Center for Medicaid and State Operations at CMS. Sessions covered a wide range of topics, including the following issues relevant to the disability field. Using the 1915(i) Medicaid State Plan Option Gale Arden, Director of the Elderly and Disabled Program at CMS, started the session by discussing the differences between Money Follows the Person grants, the 1915(i) state plan option, and the 1915(c) waiver. CMS is seeking to move the Long-Term Support system to a person-centered system that offers a range of choices. Ms. Arden described a number of critical elements of a balanced system and the ways that CMS is currently rebalancing the system, including tools to measure progress. One current initiative is the Money Follows the Person (MFP) rebalancing program that has 31 state demonstration grants. The MFP assists states in shifting money from institutional settings to community supports. The project period runs through September 30, 2011. The 1915(i) allows states to amend their state plan to offer Home-and Community-Based Services (HCBS) through the state plan. In addition, 1915(i) breaks the eligibility link between HCBS and institutional care now required under 1915(c) waivers; in other words, an individual no longer needs to qualify for an institution to receive HCBS. 1915(i) permits the statutory 1915(c) services but not the 1915(c) “other” flexibility to design unique HCBS waiver services. State plan HCBS is available for individuals eligible for medical assistance and whose incomes do not exceed 150 percent of the federal poverty level. Ms. Arden also detailed the quality measures that CMS is partnering with the Agency for Healthcare Research and Quality (AHRQ) to develop. Finally, CMS is working on a Dear State Medicaid Director Letter and proposed regulations that are targeted to be released in March. Gene Gessow, Medicaid Director for the state of Iowa, detailed the 1915(i) plan that Iowa has implemented. Iowa was the first state to have the 1915(i) approved and the plan focuses on case management and habilitation. Iowa’s Medicaid program provides traditional and supportive services and has a separation of rehabilitative and non-rehabilitative services. Under the Iowa plan, HCBS habilitation services can be non-rehab state plan benefit authorized under the Deficit Reduction Act of 2005. The adoption of the 1915(i) was not a difficult process for Iowa, the biggest challenge was determining the method to pay for services. The plan was implemented in April 2007 and will be reviewed in two years. According to CMS officials, there are three pending applications; Nevada, Colorado, and Georgia. Long-Term Care Update: Release of the 2007 NASMD Long-Term Care Survey Martha Roherty, Director of NASMD, was introduced by Washington State Medicaid director Doug Porter. Ms. Roherty began her presentation with an overview of the NASMD Long-Term Care Survey, which consisted of 83 questions and was developed by the Chronic Care and Eligibility Technical Advisory Groups. The survey was completed by 43 states and two territories. Ms. Roherty also gave an overview of changes in the Deficit Reduction Act of 2005 (DRA), eligibility, Long-Term Care Partnership Programs, the Family Opportunity Act, Money Follows the Person grants, HCBS and Personal Care services. She then reviewed the demographics of the aging population, and usage of HBCS. She went on to discuss the Family Opportunity Act, which most states opted not to participate in, as they were concerned the funds would be short term. The survey also demonstrated that most states opted to stay with the waiver plan rather than switch to the state plan. There was little response due to the lack of federal guidance, the increase in state costs, and the cap on eligibility. She went on to discuss state innovations including one stop resource centers, spouses as paid care givers, screening tools, and targeted case management. --------------------------------------------------------------------------------------- 6. Groups Back Expansion of Care in Homes, Community, But
Question Transition Rules VOR Summary: This article relates to a Congressional House Hearing held earlier this week regarding the Community Choice Act of 2007 (aka MiCASSA). Comments by proponents of the bill, included in the article below, perpetuate some of the myths that surround the community v. facility debate (e.g., it is cheaper to serve people in the community). What is not mentioned is that the original Congressional Budget Office analysis of MiCASSA (predecessors to the current Community Choice Act) estimated that the new personal attendant care entitlement will cost the federal government an additional $10-20 billion in new federal funding annually. For this reason, VOR has opposed the Community Choice Act (see VOR’s position at: http://www.vor.net/CCA2007.htm). Regarding the eligibility link between ICF/MR and Home and Community-Based Services waiver, while it is true that ICF/MR eligibility is required to receive Home and Community Based waiver services (HCBS), being a resident in an ICF/MR is not required, generally, to receive HCBS services as this article implies (cf., the Money Follows the Person program which does require that participants be ICF/MR or Nursing Facility residents). Furthermore, the article neglects to mention the relatively new State Plan Amendment option which “breaks the eligibility link between HCBS and institutional care now required under [HCBS] waivers” (see article above, quoting Gale Arden/CMS). Groups Back Expansion of Care in Homes, Community, But
Question Transition Rules Panelists at a Jan. 16 House hearing said they support legislation for state Medicaid programs to cover home and community-based services (HCBS) for people with disabilities, but were concerned about reducing Medicaid reimbursements for agencies that help people transition from nursing homes. Testifying before the Energy and Commerce Subcommittee on Health, Stephanie Thomas, co-director of the Institute for Disability Access, explained that up to 300,000 people currently in nursing homes have "expressed a preference for home and community-based services," allowing them to get personal care attendants in their own homes instead of having to live in a nursing home or another institutional setting. Legislation introduced by Rep. Danny Davis (D-Ill.) last March, the proposed Community Choice Act of 2007 (H.R. 1621), would give people the choice to use attendants, Thomas told the panel. She added that "case management is vital" and voiced concern about a Centers for Medicare & Medicaid Services rule to change the number of days that qualify for Medicaid reimbursement for agencies that help people transition from nursing homes to home and community-based settings. CMS Rule Celine Fortin, associate executive director of the Arc of New Jersey, explained that under an interim final rule CMS issued Dec. 4, 2007, with a public comment period (72 Fed. Reg. 68077), CMS reduced from 180 to 60 the number of days Medicaid covers for transition services offered to people moving out of nursing homes. She told the committee that the reduction makes the transition "difficult." The CMS rule on Optional State Plan Case Management Services specifies that "individuals may be considered to be transitioning to the community during the last 60 consecutive days (or a shorter period specified by the State) of a covered, long-term, institutional stay that is 180 consecutive days or longer in duration. For a covered, short-term, institutional stay of less than 180 consecutive days, individuals may be considered to be transitioning to the community during the last 14 days before discharge." Thomas told BNA that the shortened time period is a "problem because people with disabilities often don't have an ID, they need to get community aid, they need to get an apartment, all of which is not easy to do and it takes a lot of time." CMS is taking public comments on the interim final rule until Feb. 4 before it takes effect on March 3 (No. 231 HCDR 12/3/07 a0b5m3u8b1). Support for Program Expansion While states can obtain a Medicaid waiver to establish home
and community-based services options, there is increasing
support for allowing states to include the services as part of
their state Medicaid plans. "Community-based service is cost-effective and provides better quality of care," said Rep. Nathan Deal (R-Ga.), the subcommittee's ranking member. He added that CMS plans to publish a Federal Register proposed rule Jan. 18 on the personal assistance services, which indicates that the agency is "moving forward" to encourage states to establish HCBS. CMS first announced the proposed rule Jan. 14, providing guidance to state Medicaid officials who want to administer the self-directed personal assistance services to allow Medicaid recipients to hire, direct, and manage people helping them with daily living activities (No. 9 HCDR, 1/15/08 a0b5r1j1n5 ). The panelists said they also support the proposed Community Living Assistance Services and Support Act (H.R. 3001), legislation introduced by subcommittee Chairman Frank Pallone Jr. (D-N.J.) to create a national insurance program that allows people with disabilities to "purchase nonmedical services and supports that the beneficiary needs to maintain independence." "With the introduction of the CLASS Act last year, I aimed to offer a new approach that builds upon our existing safety net system and helps our elderly and disabled finance the long term care they need to remain active members of their communities," Pallone said at the hearing. Waiting Lists and 'Institutional Bias' During the hearing, committee Chairman John D. Dingell (D-Mich.) noted that 260,000 people were on waiting lists in 2005 for the home and community-based services, which indicates that there is a need for the services. Dingell joined witnesses in expressing concerns about first needing to be in a nursing home to get Medicaid benefits for home and community-based services. He said that, while the "Money Follows Person" initiative, providing states with enhanced funding to help people transition back to their communities, is "a good start, [it] has an unfortunate requirement that a person must first live in an institution six months in order to be eligible for this transition." Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, echoed the sentiment, saying "institutionalization should not be the ticket to home and community-based services." Deal added that the proposed Community Choice Act would
"reverse institutional bias which has reduced access to care at
home." REFERRAL/MEMBERSHIP/CONTRIBUTION FORM TO JOIN OR CONTRIBUTE: $25 per individual, $150 per family organization, or $200 per provider/professional organization. Extra donations are welcome! You may pay by credit card or check. TO REFER SOMEONE TO VOR: Use the form below, including the additional sections for referrals. Mail the completed form (if joining or contributing) with payment to: Voice of the Retarded FOR REFERRALS: ____ The contact information provided is for someone I think would consider membership with VOR. FOR REFERRALS: _____ You may use my name in any correspondence with this individual. My name is ________________________. ____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _________________________________________________ VOR now accepts Master Card and Visa. If paying by credit card, please provide the following information: Amount to charge to card: ___$1,000 ___$500 ___$250 ___$150 ___$50 ___$25 $_____ Other amount _____ Mastercard Card Number: ___________________________________ Expiration Date: __________________________________ Cardholder's Signature: ___________________________ ======================================================= |
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VOR * 836 S. Arlington Heights Rd., #351 * Elk Grove Village, Illinois * 60007 877-399-4VOR ph. * 847-258-5273 fax * tamie327@hotmail.com |
