CMS publishes new rules for Medicaid-funded Home and Community Based Services

CMS, (The Centers for Medicare and Medicaid Services), the federal agency that regulates Medicaid, has published final rules on Home and Community Based Services (HCBS). The rules affecting people with developmental disabilities and the settings that may be eligible for continued HCBS funding remain controversial, but they are better than the rules proposed back in 2012.  Much of the responsibility for defining "community" settings that are eligible for funding Home and Community Based Services has been shifted back to the states, but they will require the approval by CMS of amendments to state plans.

We will all need to pay attention to Michigan's plans to implement the new CMS rules and make sure that everyone who wishes to have a say in how the State approaches new requirements is informed and ready to respond.

This is from the Michigan Department of Community Health:

CMS has placed links to several important items regarding the new rule defining HCBS settings at http://www.medicaid.gov/hcbs, including:

·         The text of the Final Rule
·         An Information Bulletin on the Final Rule
·         A press release announcing the Final Rule
·         Four factsheets:
o   An overview of the regulation
o   Changes to 1915 (c)
o   Changes to 1915 (i)
o   Summary of Key Provisions

The site also announces the dates and times of two Webinars open to the general public:
 

• January 23, 2014: 1:00pm - 3:00pm  Public Webinar on HCBS Final Rule
• January 30, 2014: 1:00pm - 3:00pm  (repeat) Public Webinar on HCBS Final Rule

Thank you,

Lori Mitchell
Community Practices and Innovations Section Secretary
Division of Quality Management & Planning
Bureau of Community Based Services
Department of Community Health
Lewis Cass Building, 5th Floor
Lansing, MI 48913
Telephone: (517) 335-3032
Fax: (517) 241-2969
Email: MitchellL10@michigan.gov

Public Forum on Integrated Care for people eligible for both Medicaid and Medicare

This is a notice from the Michigan Department of Community Health about a public forum on the integration of care for people eligible for both Medicaid and Medicare. The state is implementing a plan approved by the federal Centers for Medicare and Medicaid Services. As far as I know, the details of the plan have not changed much from the plan described here. The plan would cover mental health services as well as medical care. It has an opt-out provision for beneficiaries who do not wish to participate. The plan is being implemented in a limited number of regions in the state that does not include the four counties in southeast Michigan - Washtenaw, Lenawee, Livingston, and Munroe Counties.

****************************************

Dear Stakeholder:

The Michigan Department of Community Health (MDCH) will be hosting a public forum on the state’s plan to integrate care for individuals who are dually eligible for Medicare and Medicaid on January 28, 2014 at the Radisson Plaza Hotel and Suites, located at 100 W. Michigan Avenue in Kalamazoo.  The forum will be held in the Arcadia Ballroom located on the main level from 10:00 a.m. to 12:00 noon EST.

MDCH is providing a conference line for interested stakeholders to participate by phone.  The conference line information is also posted on the Integrated Care website.

Call-in number: 888-363-4734
Access number: 4162210

There are 250 lines available on a first come first served basis.  We encourage organizations to listen in groups in order to maximize lines available for others.  If you get a message stating “Please try your call again later”, all lines are full.
  
Prior to the forum, the presentation will be available on the Integrated Care website which can be found at the following web address: http://www.michigan.gov/mdch/0,4612,7-132-2939__2939__2939-259203--,00.html

A local map to the Radisson Plaza Hotel and Suites can be found here: http://www.radisson.com/kalamazoo-hotel-mi-49007/mikalama/area/map

The address for personal GPS and online mapping systems is:

100 W. Michigan Avenue, Kalamazoo, MI 49007

Parking is available in the hotel’s attached parking garage. Green parking passes will be available at the forum registration table to cover the cost of parking for participants.  When leaving the parking garage, enter your parking ticket into the machine followed by the green parking pass to avoid a parking fee.

Complimentary valet parking is available to those utilizing wheelchairs or with accessibility/mobility issues.

For interpreting services, or other accommodations at the forum, contact the Integrated Care Division at 517-241-4293.
 

Schoolgirl Signs Christmas Songs for Deaf Parents

Kansas poised to turn over DD services to for-profit health plans

This is from an article in Kaiser Health News posted on 12/5/13 called  "In Kansas, A Fight Over Developmentally Disabled Shifting To Medicaid Managed Care" by Jenni Bergal. According to the article, Kansas is poised to hand over all home and community-based services for 8,500 people with developmental disabilities to three for-profit Medicaid managed health plans on January 1, 2014:

"…What concerns families and advocates the most is that the three for-profit national insurance companies that run KanCare [the program through which the State of Kansas administers Medicaid] will be responsible for a statewide program that they’ve never managed in Kansas or elsewhere. They’re also worried that the need to make a profit ultimately will destroy a system families and advocates think works well.

"While Kansas will become the first state to make such a leap, it is being watched closely elsewhere, as at least two other states – Louisiana and New Hampshire – are considering moving in the same direction.

“'This is an unprecedented model. No state has ever taken a developmental disability population and placed it in an arrangement like this, with an out-of-state managed care system, all at once,' said Rocky Nichols, executive director of the Disability Rights Center of Kansas, a legal advocacy group. 'It’s almost like throwing everyone into the deep end of the pool.'"
 
Families believe the current system is working well and wonder why the state would take such risks with their DD family members:

"In Kansas, where a network of community-based nonprofit organizations and county agencies oversee these services, individuals can choose a case manager, who visits them at home and coordinates their care. In some cases, those relationships go back decades. While these organizations will continue to determine what services clients are eligible for and case managers will work with families to arrange that care, ultimately the health plans will be responsible.

“'There is a great deal of fear in the community that these big private health plans don’t know much about this population,' said Maureen Fitzgerald, disability rights director for The Arc, a national advocacy organization for the developmentally disabled. 'These are such vulnerable people. Mistakes that are just inconvenient to some can be devastating to them. If the home care person doesn’t show up, you could be lying in your bed all day. It’s kind of scary.'

"Only a handful of states, including Michigan and Vermont, have moved the developmentally disabled into managed care for long-term services. They’ve mostly relied on existing networks of community-based nonprofits or county agencies or have made themselves the managed care organization. None has turned exclusively to national managed care companies."

The health plans currently manage the medical care for people with developmental disabilities, but not the non-medical care and social services that so many rely on.

The article continues:

"[Governor] Brownback, a Republican, has said that KanCare will improve care coordination and reduce growth in Medicaid spending for the state and federal government by $1 billion over five years.

"Although the frail elderly, physically disabled and mentally ill are now getting long-term services through KanCare, inclusion of the developmentally disabled was delayed until 2014 by the legislature following bitter protests from parents, advocates and providers. Lawmakers wouldn’t yield again, even as more than 1,000 people rallied outside the Capitol in Topeka in May, many wearing red T-shirts that read: 'Not Worth the Gamble.'"

The state says that nervous providers have gotten families unnecessarily riled up about the plan, and has assured them that services won't be cut. 

"…But many are skeptical. They fear that the managed care companies will seek to boost profits by reducing services or driving some small providers out of business because of payment delays or denials. The companies say these concerns are unfounded and insist that services will be maintained and providers paid promptly."

This is certainly a situation that warrants watching. Kansas is going to turn over the management of home and community-based services for people with developmental disabilities to for-profit health plans that have no experience serving this population but are very good at making money. What could possibly go wrong?

Kaiser Health News (KHN) is a nonprofit news organization committed to in-depth coverage of health care policy and politics.

Poem for a Lucky cat

Lucky and Grandpa

My 15-year-old cat Lucky had to be put to sleep today. She was a fine old cat and a constant, if needy, friend. This is an ancient Irish poem written by a 9th century Irish monk about his cat. Lucky was just like Pangur Ban except Lucky was a "she" and not a "he", she was not Irish although she had the luck of the Irish, and she did not chase mice but had a preference for chipmunks. I am not a monk and I am too tired to sit all night hunting words. But I like the poem, especially the line "In our arts we find our bliss, I have mine, and he has his."

Pangur Ban

I and Pangur Ban, my cat,
'Tis a like task we are at;
Hunting mice is his delight,
Hunting words I sit all night.

Better far than praise of men
'Tis to sit with book and pen;
Pangur bears me no ill will;
He, too, plies his simple skill.

'Tis a merry thing to see
At our task how glad are we,
When at home we sit and find
Entertainment to our mind.

Oftentimes a mouse will stray
Into the hero Pangur's way;
Oftentimes my keen thought set
Takes a meaning in its net.

'Gainst the wall he sets his eye
Full and fierce and sharp and sly;
'Gainst the wall of knowledge I
All my little wisdom try.

When a mouse darts from its den.
O how glad is Pangur then!
O what gladness do I prove
When I solve the doubts I love!

So in peace our tasks we ply,
Pangur Ban, my cat and I;
In our arts we find our bliss,
I have mine, and he has his.

Practice every day has made
Pangur perfect in his trade ;
I get wisdom day and night,
Turning Darkness into light.'

Lucy the dog and Lucky the cat: BFFs

Steep cuts to Detroit area mental health budgets

This if from the DDadvocates Newsletter, November 2013, by Ed Diegel:

Welcome the Detroit Wayne County Mental Health Authority 

Lobby Against unprecedented Cuts to Mental Health Budgets in the Tri County Area

We have been slow to acknowledge the new Detroit Wayne County Mental Health Authority and to welcome its new leader, Tom Watkins. We should all do this as birth of the new Authority represents a first step away from complaints of bad politics and county mismanagement of the old Detroit Wayne County Mental Health Agency.

The new organization is barely on board and the State has announced steep cuts to the Wayne, Macomb and Oakland Mental Health Budgets for the 2014 Fiscal Year which began October 1, 2013.

For Wayne County the cuts are $15.0 million. So much for the State commitment to one of the most impoverished areas in the country. Macomb and Oakland cuts will be 11% and 7% respectively. The cuts effective October 1, 2013 were not announced until September 27, 2013! This timing comes from an administration that wants to run the state like a business. No successful business does such poor planning that it announces policy shifts and budget
actions of this magnitude 3 days before a budget cycle. The rationale for the cuts is that Wayne, Oakland and Macomb receive a disproportionate share of the state’s Medicaid dollars and therefore these reductions followed by incremental 5% reductions each year over time were put in place. There is no attempt here to measure the disproportionate concentration or severity of persons served, or differences in cost of living or other factors that a reasonable party might use. Furthermore according to one analysis, there is within the plan also disproportionate reduction of funding for persons with Developmental Disabilities.

To my knowledge, this is not a legislative action—the State Department of Mental Health led by Mr. James Haveman is responsible for this action. Furthermore, it is of such significant importance that the Directors of Mental Health in the three counties sent a joint letter of protest to Lansing—hopefully this is a sign of a new era of cooperation flowing from the new Authority.

What to do?

Please do this today—

1. Go to the new DWMHA web site  Go to the Contact Us page and send a message to Tom Watkins welcoming him and encouraging him and his staff in the new organization. Take the time to mention any gaps or unmet needs you are aware of in
   service delivery to persons with developmental disabilities.
2. Go to the DWMHA Home Page and find the link to your legislators
3. Use the link to send a note to your Representative and your Senator and inform them that the so-called Mental Health rebasing action will further dismantle services in the most needy counties of the state, is ill conceived and will create yet further economic burden in the tri county area. 
4.  Ask each of them to tell you what they will do to intercede. Don’t assume your legislator will support you in this. Remember, most Wayne County legislators voted AGAINST the creation on the newAuthority!

Thanks, and Happy Thanksgiving to each of you!!
 
Ed Diegel,
Advocates for Persons with Developmental Disabilities in Wayne County.
ddadvocates@gmail.com
and now at ddADVOCATES.com

Ann Arbor paper recognizes a local hero

This is from Ann Arbor Family, a free local advertising paper that features stories about people and events in the Ann Arbor area. Stephanie is one of my own personal local heroes from Just Us Club, a non-profit organization that provides after school care, an adult activity program, and respite care  for  children and adults with moderate to severe disabilities.

 Special needs Helping Heroes by Nan Bauer:

Stephanie Swain 
Program Director for the Just Us Club

Coming from an Ypsilanti family of 11 kids, Stephanie Swain realized early on that she had a heart for childcare. A Special Ed teacher by day at the High Point School in Ann Arbor, Stephanie’s the program director for the Just Us Club, an after school option open to any students with disabilities who can function in a group setting. “We have a huge range of kids here: cerebral palsy, muscular dystrophy, Down syndrome, autism spectrum,” she says. “We have a pretty unstructured program, because the kids want to relax after a day at school, so we play games, do art, and we have music therapy once a week.” She also offers respite care, giving parents some precious free time while she hangs out with the kids. Even with her jam-packed schedule, she’s found time to continue her education and is on the verge of receiving her master’s degree and gearing up for a PhD. “I’m super passionate about helping parents understand their kids’ behaviors,” she says. “If I can help alleviate some of the anxiety that parents can feel when their child has a meltdown or just acts up in an extreme way, the environment gets better for the whole family.”

Learn more about the  Just Us Club at justusclub.org/contacts.html