Forwarded by the Disability Rights Network of Pennsylvania -
This week, Monday and Tuesday are critical for the people of Pennsylvania! Act Now!! Take a stand against HB 461 and in support of HB 806, an alternative that better serves PA!
Oppose HB 461
On Monday, June 3, the House Health Committee meets about HB 461, which seeks to increase the Human Services Block grant from 20 to 30 counties. An amendment will be offered that expands the bill to make the block grant available to “any willing county.” MHAPA and many others oppose HB 461. There is no research or data to show whether the block grant has benefited (or harmed) individuals who need behavioral health services in the counties in which it’s been implemented this year. Without knowing its impact, good or bad, we do not support expansion and neither should legislators.
Speak out NOW! Please contact members of the House Health Committee and House leadership to oppose HB 461 and the amendment. Find the Committee here and House leadershiphere.
Support HB 806
On Tuesday, June 4, the House Human Services committee meets to vote on HB 806, which is Representative Gene DiGirolamo’s alternative to the block grant proposal (HB 461). The bill repeals the block grant but provides flexibility so counties can move unexpended funds at the end of the fiscal year. The legislation defines “surplus human services funds” and provides guidelines for how and when the surplus can be used. We support HB 806 but oppose any proposal that seeks to add the "any willing county" language to this bill as well.
The Human Services Committee needs to know that you support HB 806, which repeals the block grant and protects the funding for critical community-based behavioral heatlh services. Contact the House Human Services Committee TODAY! Find members here. Tell them you support HB 806 but oppose the proposal to add “any willing county” to the bill.
House Bill 1114 was just introduced to Committee. It is a Bill of Rights that will protect individuals with intellectual disabilities and our families. It looks at the development of a five year plan to address the waiting list.
(Jan. 9) – Gov. Tom Corbett said Wednesday the administration is considering adding more money to intellectual disabilities programs in an effort to reduce the number of individuals on a waiting list.*
Corbett said the administration is shaping its budget proposal for its February announcement and plans to announce an increase in funds to further reduce the intellectual disabilities waiting list of about 15,000 people. He said $20 million could be added to move some people off the waiting list and into the program. “We believe we’re going to be in the position to put an additional $20 million into dealing with those people and reducing the waiting list that they’re going through right now,” Corbett said Wednesday after speaking to middle schoolers of the Pine Grove School District. *Corbett told Vision for Equality, a Philadelphia- based intellectual disabilities advocacy group, he would make reducing the list a priority, and said Thursday social welfare dollars should be focused on helping severely mentally and physically disabled people. “Back in November, I met with a group of them down in Philadelphia. Severely intellectually and, in some cases, physically disabled – and we have a waiting list for those people,” he said.* *“To me, when we’re talking about social welfare dollars that we have, they ought to be at the top of the pile, not halfway down or at the bottom,” he said. “So we’re beginning our effort to move them up and hopefully you’re gonna see us able to put … more money in there to reduce the waiting list.”* In the 2012-13 state budget, $17.8 million earmarked for reducing the list helped take about 1,100 off the list and into programs, including young adults who are “aging out” of the system and adults with aging parents who are at risk of no longer being able to care for them. The services those individuals are waiting to use include home and personal care, therapy, work programs and assistance for those can’t help take care of themselves because of disabilities such as autism or Down syndrome. Various groups have criticized Corbett and his administration for eliminating the cash assistance welfare program, changing financial management services for disabled individuals, and cutting funds for community-based programs such as behavioral health services, mental health services, child welfare and homeless assistance.
I am pleased to announce the consolidation of several Department of Public Welfare (DPW) licensing and inspection functions into a single Bureau of Human Services Licensing (BHSL).
This initiative will involve the consolidation of licensing functions currently administered in several DPW program offices into a single administrative bureau within the department’s Office of Administration. By consolidating licensing functions, the department seeks to increase efficiency by eliminating duplicative administrative structures, and to improve its regulatory protection of vulnerable populations.
We take this step in recognition that human service licensing is a professional discipline, and that a single, consolidated licensing bureau can provide the highest level of professional development and support for inspectors, and thereby, provide better health, safety and rights protections for people served in licensed settings. In addition, the consolidation will provide better, more consistent across-the-board decision-making for regulatory application, interpretation and enforcement, particularly for those human services providers who serve multiple populations.
The initial phase of the initiative, scheduled for July 1, 2012, will involve Licensing Management and Research (licensing databases and managerial support), and Adult Residential Licensing (personal care homes) from the Office of Administration; Community Home, Family Living Home, Adult Training Facility, and Vocational Facility licensing from the Office of Developmental Programs; and Child Residential Licensing from the Office of Children, Youth and Families. Other department licensing functions will be included at later dates.
I hope you share our optimism for the success of this initiative. Please feel free to contact Mr. Ron Melusky, Director of Human Services Licensing, at 717-783-3670.
Centers for Medicare & Medicaid Services (CMS) Releases Two New Rules On April 26, CMS released two rules that support state efforts to expand access to home and community based services for people with disabilities.
CMCS Informational Bulletin
DATE: April 26, 2012
FROM: Cindy Mann, Director
Center for Medicaid and CHIP Services (CMCS)
SUBJECT: Release of Home and Community-Based Services Rules
Today, the Centers for Medicare & Medicaid Services (CMS) is releasing two rules that support State efforts to expand access to home and community based services (HCBS) for people with disabilities:
• Final Rule: Community First Choice (CMS-2337-F)
• Notice of Proposed Rulemaking: Home and Community-Based State Plan Benefit (CMS-2249-P2), otherwise known as the "1915(i)" notice of proposed rulemaking.
Community First Choice (CMS-2337-F)
This final rule implements the Community First Choice State plan option, which was authorized by the Affordable Care Act and provides an incentive for States to expand Medicaid coverage for person-centered home and community-based attendant services and supports. States that elect the Community First Choice option are eligible for a 6 percentage point increase in their federal medical assistance percentage. Individuals who require an institutional level of care are eligible for the services, which will be offered in community-based settings.
The Affordable Care Act directs that the Community First Choice benefit may only be available in a "home or community" setting, and this rule does not finalize language regarding the definition for such settings. CMS articulated standards for settings in Community First Choice’s proposed rule, but based on the comments the agency received, CMS decided to revise the standard and seek public comment again. The revised standard is in the 1915(i) proposed regulation that CMS released today (discussed below.)
While the settings requirements are proposed, the Community First Choice option is in full effect, and CMS will rely upon these proposed provisions as we review new State plan amendments to implement the Community First Choice option. To the extent that there are changes when the settings standard is finalized, we are committed to offering States a reasonable transition period (of not less than one year) to make any needed changes to come into compliance with the final rule so as to minimize any disruption to State systems that were established in compliance with the proposed regulations.
CMCS Informational Bulletin, Page 2
1915(i) Notice of Proposed Rulemaking (CMS-2249-P2)
This notice of proposed rulemaking defines and describes the option available to States under section 1915(i) of the Social Security Act, first authorized in 2005 and enhanced by the Affordable Care Act. This option permits States to offer home and community-based services under the Medicaid State plan without the use of a waiver. As a result, States will have the ability to provide a full array of home and community-based services to individuals who do not qualify for an institutional level of care but have significant services needs, which can include individuals with mental health conditions, Autism Spectrum Disorder, acquired immune deficiency syndrome, or Alzheimer’s disease.
The rule also contains other provisions related to home and community based services, including:
• A proposed definition of home and community based settings that will serve as a common definition for services offered through the Community First Choice option and the 1915(i) State plan option.
• A five-year approval or renewal period for demonstration and waivers programs through which a State serves individuals who are dually eligible for Medicare and Medicaid benefits.
This notice of proposed rulemaking is open for public comment for 30 days after publication in the Federal Register. Please refer to the Federal Register for specific instructions about submitting comments.
The rule is displayed at: https://www.federalregister.gov/articles/2012/05/03/2012-10385/state-plan-home-and-community-based-services-5-year-period-for-waivers-etc-medicaid-program
Additional information is available at: http://www.cms.gov/apps/media/fact_sheets.asp
The rule is displayed at: https://www.federalregister.gov/articles/2012/05/07/2012-10294/medicaid-program-community-first-choice-option
Additional information is available at: http://www.cms.gov/apps/media/fact_sheets.asp
The revised form has a new number, CY113 (UF) 6/11, located in the bottom right hand corner of the form. Information can be typed directly into the form. Users must have a licensed version of Adobe Acrobat Reader to enter data, but will not be able to save the form with information entered. Instead, the person completing the form must print the form immediately after entering in order to maintain and submit the information. A blank copy of the form can be saved on a user's computer for future use.
The form is now available in English and Spanish. The clearance section includes more options from which to choose such as: o Child care services employee o Foster care
Employment with a significant likelihood of regular contact with children
DPW Employment & Training Program participants
Instructions for completing the form are attached to the form; instructions will print with the completed document. DPW will continue to accept the old form until April 1, 2013.
Child abuse clearances must continue to be mailed via the US Postal service. DPW is encouraging agencies, businesses, and organizations to use the electronic form to produce their own copies. The ChildLine Verification Unit will accept copies of the form as long as the applicant's signature appears. Questions may be directed to Terry Clark (firstname.lastname@example.org or 717-214-9545).
A Health Care Reform Blog––Bob Laszewski's review of the latest developments in federal health policy, health care reform, and marketplace activities in the health care financing business.
Wednesday, March 28, 2012
If the Supreme Court Overturns the Individual Mandate
First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.
But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care patents. “Surprisingly,” the Court ruled against the industry.
Whatever the justices are now thinking, there isn’t a lot anyone could do differently until we actually get a ruling and know exactly what gets thrown out, if anything, in the 2,800-page law.
But if the mandate is overthrown, then what?
First, exactly how the Court rules on severability will be critical. What could go out with the mandate?
The Obama administration has smartly tried to build a firewall around the rest of the Affordable Care Act (ACA) by arguing before the Court that only the insurance reform elements of the bill should fall if the mandate goes down—that the mandate is the only quid pro quo for the insurance industry in exchange for taking all comers. That looks to me like the most logical outcome for overturning the mandate—but my perspective is one of an insurance veteran not a Court expert.
The Obama firewall strategy is a smart strategy for two reasons. First, it leaves the rest of the health law standing. Second, losing the most popular part of the new law, the insurance reforms, leaves the administration with lots of political leverage later on to fix the bill. Ironically, the Court, in accepting the Obama arguments, would be overturning both the most unpopular element of the law as well as the most popular.
From a policy perspective, I would see fixing the law in the wake of losing just the the mandate an easy thing to do. In place of the individual mandate, I would suggest a provision that:
Has no mandate for any individual to buy insurance.
Allow individuals and families to be able to buy insurance at any time.
Upon purchase, everyone in the family would be covered under any of the plans available.
But, if the insurance were not purchased at any time the individual was newly eligible, any preexisting condition would not be covered for two years.
Such a solution would provide guaranteed insurability if the insurance was purchased when first offered, no mandate to buy, people could purchase at any time and be covered, other family members would not be penalized, and the insurance pool would be protected.
The policy fix is easy.
But politically, in the current hyperpartisan environment, the Republicans have no interest in helping the administration fix the Affordable Care Act. Until both sides are willing to work together on a comprehensive compromise on health reform, there will be no fixes.
What happens if the mandate falls, the Court leaves the insurance reforms in place, and the political paralysis continues?
New Jersey. That state has had insurance reform and no mandate for a number of years and it’s a mess—even more unaffordable rates and enormous anti-selection in the insurance market.
The lack of a mandate won’t hurt the larger already efficient employer market and it won’t help the already problematic small group market. The employer mandate for those with more than 50 employees would continue.
In the exchanges, where the ACA would provide good subsidies for the poor and near poor, there would likely be adequate spread of risk among these lower income groups in a completely voluntary market because the insurance is affordable. But higher insurance rates will mean the CBO’s estimates for the cost of the subsidies will be way off. Remember, the ACA’s subsidy system caps the cost for health insurance based upon income—higher insurance premiums mean higher federal costs.
Without a mandate and with the insurance reforms still in effect, the anti-selection would be most pronounced in the middleclass where the subsidies were always insufficient anyway.
What happens if the Court throws out the mandate as well as the insurance reforms? The insurance industry would get the benefit of many more customers because the subsidies would still be in place. But they would be healthy because the insurance underwriting and pre-existing condition provisions would remain. While the insurance industry would do well, the providers would still suffer the ACA's payment cuts and not have as many patients coming in with insurance cards as they expected—particularly the most sick and costly for them.
If the Court throws out the individual mandate, as well as perhaps the insurance reforms, the law would have to be fixed.
But the political environment would have to change markedly before Republicans and Democrats could come together on a comprehensive fix to the new law.
On December 1, 2011, the Disability Rights Network (DRN) Íiled a lawsuit in federal court on behalf of individuals who have disabilities and who receive services including Community Integration (CI). DRN claims that the changes in the service definition of CI will cause individuals to lose services and to be institutionalized. The presiding Judge has placed the matter in “civil suspense” for six months commencing on April l, 2012. This means that no action will be taken in the matter during that period. The purpose of this amendment is to revise the “Community Integration” service defìnition to reflect the proposed settlement with the Judge.
Service Title: | Community Integration effective 04/0_1/2012
Complete this part for a renewal application or a new waiver that replaces an existing waiver. Select one.'
Service is included in approved Waiver. There is no change in service specifications.
Service is included in approved Waiver. The service specifications have been modified.
Service is not included inthe approved Waiver.
Service Definition (Scope): Integration is a _short-term, goal*-_based support service designed to assist participants in acquiring, retaining, and improving self-help, communication, and ,adaptive skills necessary to reside in the community. integration can inc1ude'cuein'g and modeling of behavior to assist the participant in developing or maintaining maximum independent functioning in-community living activities including domestic and leisure activities. Community Integration is goalbased and situational to assist individuals in achieving maximum functionduring events such as a transition from a nursing facility; moving to a new community or from a parent's' or a change incondition that requires new skill sets, Services must focus on specific skills and be related to the expected outcomes outlined in the partieipant’s service plan. ;Community Integration goals must be reviewed and/or updated at least quarterly by the Service Coordinator in conjunction with the participant to assure that expected outcomes are met andthe service 'plan is modified laccordingly. Specify applicable (if any) limits on the amount, frequency, or duration of this service: iCommunity Integration cannot be bi11ed`simtaneously with Residential Habilitation Personal asistance Services» commurńty Integration is reviewed quarterly to determine" the progress of how the strategies utilized are affecting the participar1t’s ability to independently complete tasks identified in the ISP. If the individual can complete the task independently, then the goa land _CI service should be removed from the-ISP. The length of service should not exceed thirteen .(13)Weeks on new plans. lf the participant has not reached the goal at the end of 13 Weeks, then documentation of the instrucation for continued training on the desired outcome must be incoorporated into the lSP at the review. participant has not reached his/her CI goals by the end of twenty¿siX,(26) Weeks','the goals need to change or it is concluded that the individual will not independently complete the goal andthe SC must assess for a more appropriate service to meet the individua1’s need. distinct goal may' nót remain on the ISP for longer than twenty-six (26) Weeks.retains the discretion to 1) aúthorize CI. for individuals who have not experienced a “1ife- event; 2) authorize more than 48 units (12 hours) ofCI in one week for up to 21 hours per goals
Pennsylvania Department of Public Welfare Office of Developmental Programs
Availability of ODP Consolidated and Person/Family Directed Support Waiver Renewal Applications Submitted to CMS
ODP Communication Number: Announcement 022-12
Individuals and Families, Administrative Entities (AEs), Supports Coordinators (SCs), SC Supervisors, Supports Coordination Organizations (SCOs), Providers, and other interested parties.
The purpose of this announcement is to inform all interested parties that the Consolidated and Person/Family Directed Support (P/FDS) Waiver renewal applications are available on the Department of Public Welfare (DPW) website. These Waivers were submitted to the Centers for Medicare and Medicaid Services (CMS) on March 1, 2012.
Home and Community-Based Waivers permitted under Section 1915(c) of the Social Security Act are approved by CMS for five-year renewal periods, with the exception of new Waivers. The current Consolidated and P/FDS Waivers expire on June 30, 2012. ODP submitted renewal applications for the Consolidated and P/FDS Waivers to CMS on March 1, 2012. Please note that the dates documented at the bottom of each page in the Waiver renewal applications differ from the date that the applications were submitted to CMS. The date listed in the Waiver renewal applications merely reflects the date that ODP was able to download the complete Waiver renewal application from the CMS web-based application system. ODP is pleased to announce that copies of the submitted Waiver renewal applications are being made publicly available on the DPW website for the first time prior to CMS approval.
It is also important to note because these Waivers have not been approved by CMS changes may be made to the content based upon discussions with CMS during the approval process. ODP will inform all stakeholders when CMS has officially approved the Consolidated and P/FDS Waivers and will make the approved Waivers available at that time.