The Roving Activist’s Blog

The Interim Final Rules issued by the Centers for Medicare and Medicaid Services
(CMS) will reduce federal case management reimbursement targeted for transitioning people from institutional settings to the community. Under the Interim Final Rules, CMS will reduce the funding for individuals transitioning from a nursing home or other institution to a community setting, from the current 180 days to only 60 days if the individual has been institutionalized for six months or more. CMS will only allow payment for 14 days if the individual has been institutionalized for less than six months. This change undercuts efforts at the state level to comply with the Olmstead decision, implement the Money Follows the Person Demonstration programs and support people transitioning into the community from institutional placement.

Let CMS know that you oppose this change!

Here is a sample letter that you can send by postal mail:

Dennis Smith, Director of the Center for Medicaid and State Operations

Department of Health and Human Services

Attention CMS-2237-IFC

P.O. Box 8016

Baltimore, MD 21244-8016

Re: Interim Final Rule on Case Management Services

Dear Mr. Smith:

I am an advocate for people with disabilities and am deeply concerned about and oppose Interim Final Rules issued by the Centers for Medicare and Medicaid Services (CMS) which will reduce federal case management reimbursement targeted for assistance transitioning individuals from an institutional setting to the community. Under the Interim Final Rules, CMS would reduce the funding for such an individual from the current 180 days to only 60 days if the individual has been institutionalized for six months or more. CMS would only allow payment for 14 days if the individual has been institutionalized for less than six months.

CMS staff stated that the rationale for this change, in part, is that payment for transition case management is a duplication of payment to the institution which is expected to provide “discharge planning”. I strongly disagree with this assertion. Transition into the community requires a great deal of work to coordinate the services and supports individuals need to be successful. As an advocate for people with disabilities, I know that institution-based staff is unfamiliar with the complex array of community-based housing options, services, and supports that must be navigated to transition into community living. This work is particularly difficult and time-consuming because the entire plan must be in place at the same time. It is impossible to effectively put one component of a plan in place and then work on another piece.

CMS originally changed these case management rules and increased the allowable payment to address concerns that people needed additional support beyond institutional discharge planning to transition to community living. This change was made to help states comply with the Olmstead decision. Reversing this position simply strengthens the institutional bias and undercuts state transition efforts. The timing on this change is particularly devastating because states are beginning to implement their Money Follows the Person Demonstration programs. Advocates have been working with the states to use the expanded case management funding to support the work needed to make community living a viable alternative. More importantly, this funding stream would help transition people into the community long after the demonstration program is over.

I am also concerned that the payment system creates a huge disincentive for smaller non-profit organizations to do this work. Payment is made only after the individual has transitioned to the community. Smaller non-profit organizations, which have been the leaders in transitioning people out of nursing facilities, often do not have sufficient cash flow to support the work while they wait months for payment. I urge CMS to work with advocates to develop an approach which maintains accountability for the work but also addresses this concern.

Again, I urge you to retract these devastating changes.

Sincerely,

If you want things a little easier, click on the Take Action link to reach the sample letter to Dennis Smith. Please feel free to personalize the letter to reflect your own experiences. Enter your contact information, then, click Submit.

If your screen reader does not work with the capwiz system, you can e-mail your letter to: dennis.smith@cms.hhs.gov

I just found out about this…

Voice of the Retarded (VOR), has set it’s sights on Money Follows the Person (MFP) and is trying to destroy the states’ demonstration efforts.

They will be getting on the next CMS Stakeholders Call en mass.  Supporters of MFP need to get on this stakeholders call (it’s free) and support MFP and choice for people who want out to be able to get out of nursing homes or other insitutions.

The call is on January 17th at 3:00 to 4:30 pm EASTERN TIME (2 pm Central, 1 pm Mountain, 12 pm Pacific)

The call in number is  888-793-1765  and the passcode is “stakeholders“

States Without Money Follow the Person Awards

Three States applied and were rejected by CMS – Mississippi, Rhode
Island and Tennessee.

Four States, Florida, Idaho, West Virginia and New Mexico,
initially applied for a MFP grant in the first tier of
applications, were rejected (as were many States) and then did not
reapply for the second tier MFP awards.

People in nursing homes who want to live in the community

Alabama 3,651
Alaska 172
Arizona 3,188
Colorado 3,741
Florida 19,206
Idaho 1,156
Maine 1,550
Massachussetts 8,982
Minnesota 6,519
Mississippi 1,737
Montana 1,307
Nevada 1,344
New Mexico 1,675 [has a state MFP program]
Rhode Island 1,546
South Dakota 1,053
Tennessee 7,068
Utah 1,776
Vermont 711
West Virginia 1,965
Wyoming 537

CMS AWARDS GRANTS TO 13 STATES
FOR ALTERNATIVES TO NURSING HOME CARE

Thirteen states and the District of Columbia will get more than $547
million in grants over five years to build Medicaid long-term care
programs that will help keep people at home and out of institutions,
Leslie V. Norwalk, Acting Administrator of the Centers for Medicare and
Medicaid Services (CMS) announced today. 

Today’s awards are the second round of grants that will total  $1.75 billion over five years (2007-2011) to help shift Medicaid’s traditional emphasis on institutional care to a system offering greater choices that include home and community-based services. 

This “Money Follows the Person” initiative was included in the Deficit Reduction Act of 2005 (DRA), currently being implemented by CMS. It is a component of the administration’s New Freedom Initiative, a nationwide effort to remove barriers to community living for people of all ages with disabilities or chronic illnesses.

“There is more evidence than ever that people who need long-term care prefer to remain in their own homes and communities whenever possible,” said Ms. Norwalk. ”This new program will help states shift Medicaid’s traditional emphasis on institutional care to a system offering greater choices that include home-based services.

“States will also benefit by giving the elderly and people with disabilities more control over how and where they receive the Medicaid services they need.”

States expect to be able to move more than 14,000 people into community settings using these grant awards.

The Medicaid program traditionally pays for care for elderly and disabled individuals living in institutions who need help with activities of daily living. To fund home and community-based services, states must obtain waivers of normal program rules designed to pay for
care in institutions. 

“The concept of money following the person to the most appropriate setting improves beneficiary satisfaction while reducing Medicaid costs,” Ms. Norwalk said.  “We intend to keep taking steps to remove barriers and rebalance the options for Medicaid-funded long-term care.” States receiving grants today (see list below) will design programs with four major objectives:

*         Increase the use of home and community-based, rather than institutional, long-term care services;

*         Eliminate barriers or mechanisms that prevent Medicaid-eligible individuals from receiving support for appropriate and necessary long-term services in the settings of their choice;

*         Increase the ability of the state Medicaid program to assure continued provision of home and community based long-term care services to eligible individuals who choose to move from an institutional to a community setting; and

*         Ensure that procedures are in place to provide quality assurance for individuals receiving Medicaid home and community-based long-term care services and to provide for continuous quality improvement in such services. 

All states were eligible to participate in the five-year demonstration program and had to commit to provide demonstration services for at least two years.  

States receiving grant funds will qualify for a higher percentage of federal matching dollars to help cover the costs of moving people out of nursing homes and into community settings. The higher matching rate will be paid for one year after an individual moves out of an institution and into the community. The state must continue to provide community
services after that period as long as the person needs community services and is Medicaid eligible.

“These demonstration grants are a clear sign of our continued commitment to expand choice to all Medicaid beneficiaries as well as allowing them the independence to live at home and contribute to their communities,” said Ms. Norwalk.

For more details about the New Freedom Initiative, of which this demonstration is part, visit the CMS web site at:

http://www.cms.hhs.gov/newfreedom/. 

2007 MONEY FOLLOWS THE PERSON
REBALANCING DEMONSTRATION AWARDS

Award

State:
Transitions: 
Year One Award Amount:  
Five Year  Commitment:
     

Delaware

100
$132,537
$5,372,007
     
District of Columbia

1110
$2,546,569
$26,377,620
     
Georgia

1,347
$480,193
$34,091,671
     
Hawaii

415
$231,250
$10,263,736
     
Illinois

3,357
$6,879,166
$55,703,078
     
Kansas

934
$102,483
$36,787,453
     
Kentucky

431
$4,973,118
$49,831,580
     
Louisiana

760
$524,000
$30,963,664

New Jersey

590
$230,000
$30,300,000
     
North Carolina

552
$16,055
$16,897,391
     
North Dakota

110
$18,089
$8,945,209
     
Oregon

780
$80,785
$114,727,864 
     
Pennsylvania

2600
$130,609
$98,196,439
     
Virginia

1041
$13,793
$28,626,136
     
Totals

14127
$16,358,647
$547,083,848