Disability Law

Bazelon Action Alert: Comments Needed on Revised Medicaid Rules

By Danielle

The Bazelon Center for Mental Health Law just issued an action alert, calling for people to send in comments speaking out against the Centers for Medicare and Medicaid’s new proposed regulations. The action alert includes full contact information, as well as sample letters and comments.

The deadline for sending in comments is October 12, 2007.

You can read the full text of the proposed regulations here. The Bazelon Center’s summary of important points is available here, and reads in part:

However, some significant new policy statements in these proposed rules are not entirely clear and are even problematic.

? Recent CMS policy regarding payment methodology is reinforced. The rule specifically excludes the option of paying for therapeutic foster care (or similar programs, such as ACT) through a single daily rate, case rate or similar payment to the provider. Instead, individuals in these programs can receive all covered rehabilitation services, but each service must be billed separately, requiring detailed accounting by all providers.

? To qualify for reimbursement, therapeutic foster parents must be defined as providers under the state plan. Some therapeutic foster care activities are specifically not covered under this regulation, including provider recruitment, foster-parent training and other services ?if they are the responsibility of the foster care system.? The regulation is silent about how these restrictions apply if the child is not in foster care.

A second problematic part of the new rule prohibits federal payment for services that CMS deems ?intrinsic elements? of other programs. The list of programs included under this rule includes foster care, child welfare, education, child care, vocational and prevocational training programs, housing, parole and probation, juvenile justice and public guardianship. Individuals in these programs would remain eligible for Medicaid and covered rehabilitation services could be provided to them and reimbursed?but only if the services are not intrinsic elements of the other programs. ?Intrinsic elements? is undefined. In 2004, Congress rejected a CMS proposal to include similar language in the Medicaid law. It is questionable whether the agency can do this under regulation and without specific legal authority.

The proposed changes would save the federal government an estimated $180 million in one year and $2.2 billion over a five-year period?all resulting from that last problematic provision. None of those dollars would accrue to states and localities, which would have to either reduce services or pick up the slack for the lost federal revenue.

Full post as published by Mental Disability Law Blog on September 20, 2007 (boomark / email).