To assist states as they implement the final Home and Community-Based Services (HCBS) rule released in January of this year, the Centers for Medicare and Medicaid (CMS) created the Statewide Transition Plan Toolkit for Alignment with the HCBS Final Regulation’s Settings Requirements. This document provides information on the content and process of the transition plan requirements. The Arc, together with other advocates has made recommendations to improve implementation of the regulations.
Last week, the Administration for Community Living (ACL) released guidance which outlined standards for person-centered planning and self-direction. ACL has indicated that these principles will be embedded into all of the Department of Health and Human Services (HHS)-funded home and community based services (HCBS) as well as within other non-HHS-funded HCBS and long term services and support programs. All HHS entities that provide HCBS funding are expected to incorporate the principles into their regulations, guidance, and/or the technical assistance provided to states. Additional information is available in a recent ACL Blog post from Sharon Lewis, Principal Deputy Administrator of ACL and Senior Advisor on Disability Policy, HHS.
The Centers for Medicare and Medicaid Services (CMS) reposted technical assistance documents for states to assist them in complying with the new home and community-based setting rules. Documents originally posted on the CMS website were taken down and the original links are no longer active. A new set of documents was posted on March 20 and stakeholders may want to review them for any changes.
The National Council on Disability (NCD) will be holding a forum on Medicaid managed care in Chicago on March 24. This event is part of a national series that NCD is holding across the nation. Previous forums have been in Kansas and Florida. After Chicago, upcoming forums will be in California and New York. The goal of the forums is to hear about the impact of Medicaid managed care on people with disabilities, and to share the Medicaid managed care principles that NCD developed. The conversation at the forum will inform NCD in its ongoing recommendations to the federal government on the topic of Medicaid managed care.
The Medicare-Medicaid Coordination Office released its 2013 Report to Congress providing an overview of activities and accomplishments and ongoing work to improve care for Medicare-Medicaid enrollees. MMCO made three legislative recommendations to Congress:
- Streamline the appeals mechanisms available to beneficiaries through health plans and other qualified entities offering Medicare and Medicaid services;
- Improve access to needed prescription drugs for Medicare-Medicaid enrollees by making the LI NET demonstration permanent; and
- Develop a pilot for the Program for All-Inclusive Care for the Elderly (PACE) Eligibility for individuals between Ages 21 and 55.
In the report, MMCO identified two areas for further exploration that it believes may have potential to improve the experience of Medicare-Medicaid enrollees:
- Coverage standards for Medicare-Medicaid enrollees; and
- Cost-sharing rules for Qualified Medicare Beneficiaries (QMBs).
California’s Cal MediConnect demonstration to integrate and coordinate healthcare for individuals dually eligible for Medicare and Medicaid will not move forward as planned in one of eight pilot counties. The Centers for Medicare and Medicaid Services (CMS) performed a performance audit of the sole insurer selected for the duals demonstration in Orange County and found numerous problems. Orange County has the second largest population (57,000) of dually eligible individuals in the state. The demonstration is to begin April 1 in the remaining seven counties.
CMS approved the Kansas 1115 Waiver Amendment allowing the state to provide long term supports and services (LTSS) to individuals with intellectual and developmental disabilities (I/DD) through managed care. Kansas contracts with three for-profit health insurance companies for the delivery of all Medicaid services. The Kansas legislature delayed the inclusion of I/DD long term services and supports (LTSS) for one year after the start of KanCare, the Kansas managed care program. CMS imposed an additional one-month delay on the start of KanCare for I/DD LTSS due to questions it had about the program, including concerns about individuals receiving some but not all of the waiver services they need. Kansas is the first state to use private health insurers as managed care organizations for managed LTSS for individuals with I/DD.
South Carolina entered into a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to begin implementing its demonstration to align financing and coordinate care for individuals dually eligible for Medicare and Medicaid. Individuals receiving services in intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/ID) or through a home and community-based waiver will not be included in the demonstration. South Carolina is the seventh state with an MOU.
The Long Term Care Commission formally released its report to Congress which included 28 recommendations. Notably missing were recommendations about how to finance a long term care system in the United States. Five of the Commission members, who did not vote in favor of the report, issued alternative recommendations, including creation of a public insurance program that would supplement existing private insurance and family caregiver options. At this point, it is not clear what action Congress will take upon receipt of the report which is scheduled for September 30, 2013. To view the full report, visit the Center for Medicare Advocacy.
The Long Term Care Commission concluded its work without reaching agreement on how to finance long term services and supports for people with disabilities and seniors. The Commission voted 9 – 6 to issue bipartisan recommendations about the workforce and service delivery issues that it will include in its final report to be delivered to Congress. The commission was created at the end of 2012 and was required to vote on recommendations by September 12, 2013 and a final report by September 30.
Five of the six members who did not vote in favor of the report issued alternative recommendations. The five Commission members said that the time frame did not allow the Commission to make recommendations for a comprehensive long-term services system. The Commission will hold a public meeting on September 18, 2013 to release its final report.
President Obama announced his plan to name Lynnae Ruttledge to the Long Term Care Commission to replace Julian Harris, former Medicaid Director in Massachusetts, who took a position in the federal government. Ms. Ruttledge is the former Commissioner of the Rehabilitation Services Administration and current Co-Vice Chair of the National Council on Disability.
The Commission, created in the American Tax Payer Relief Act of 2012, has held four public hearings and anticipates producing draft recommendations for addressing the need for long term services and supports in the US by September 12. A final report is due September 30. The Arc submitted comments to the Long-Term Care Commission and urges disability advocates to submit comments through the Commission’s website as soon as possible.