TAKE ACTION: Help prevent changes in CMS case management rules which reinforce the institutional bias!
Wednesday, January 30th, 2008The 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


