Saturday, June 30, 2012

Comment #1 (CMS-2249-P2): CMS proposed rules for Medicaid Waivers

Comments on proposed federal rules on Home and Community Based Services waivers are due on Monday, July 2, 2012. (Michigan's HCBS Medicaid waiver for people with developmental disabilities is called the Habilitation Supports Waiver.) Here is a link to the comments that I submitted on the government website today. The rules are proposed by the Centers for Medicare and Medicaid Services (CMS), the federal agency that regulates Medicare and Medicaid. If you are submitting testimony, make sure you identity the rules with the code CMS-2249-P2. And good luck with the government Website, . I find it confusing and frustrating to use, but I did manage to get my comments submitted, so you can too!

Here is my first comment:

I am the parent of two adult sons with profound developmental disabilities who live in a group home in Ypsilanti, Michigan. They are 35 and 27 years old and are supported in part by Habilitation Supports Waivers, Michigan’s version of the Medicaid 1915(c) Home and Community Based Services Waiver....

The CMS proposed rule changes cover a variety of Medicaid waiver programs. There was a rule for the new 1915 (i) waiver program that I commented on with the assumption that its provisions are basic principles that also apply to the 1915 (c) [for people with DD] and other waiver programs. I was most interested in the proposed rules attempting to define the characteristics of home and community based settings as opposed to institutional settings.

Past attempts [see theddnewsblog posts from 5/25/11 to 7/7/11] by CMS to define characteristics of community-based settings have been contentious. Because of the wide range of needs within the population of people with disabilities, the use of these waivers must be highly individualized and CMS rules need to be sensitive to a full range of disabilities. Some advocacy organizations, especially larger groups that receive funding through a variety of federal government programs, have tried to impose an ideology of full inclusion on all people with disabilities that is simply unworkable and even harmful for people like my sons.

The CMS should be neutral in these ideological battles and write rules that follow the law and allow for individual differences. This is especially important when states and the federal government are looking for any and all ways to reduce the costs of services to people with severe disabilities. Unfortunately, the advocacy organizations often claim that
specialized programs are by their nature wrong and discriminatory and give cover to state and federal governments that close programs "because it is the right thing to do”.

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