Wednesday, April 23, 2008

Julia's Musings: Update HR 5613 Protecting the Medicaid Safety Net Act of 2008

Yesterday, the House of Representatives took up this important legislation. Under suspension of the rules Representative Dingell moved to pass the bill as amended. There was a forty minute debate regarding this legislation. After the debate there was a call for Yeas and Nays. However, the Chair announced that all further proceeding would be postponed.

Background on the legislation:

• H.R. 5613 Protecting the Medicaid Safety Net Act of 2008
o One year moratorium on Medicaid regulations
o Moratorium includes case management, rebhab option, school based administration/transportation rules
o “Pay-As-You-Go”, Congress must find funding to pay for Medicaid Safety Act of 2008, CBO estimates cost at $1.65 billion FY 2008-09.
• Bill Sponsor: Representative John Dingell
• NC Co-Sponsors: Representatives David Price, G.K. Butterfield and Brad Miller.

The Arc of North Carolina Policy Blog has been closely following the actions of  CMS in proposing and enacting these rule changes. We believe that many of the rules go beyond the intent of the Deficit Reduction Act. These rules will have a serious affect on people with developmental disabilities and mental illness. Our most vulnerable citizens, the poor and indigent will also be affected by the proposed rule changes in Medicaid.

These rules will also affect health care service workers. According to a new study by Families USA the proposed rule changes will eliminate 11,7000 jobs and cost the state $412.1 million in wages.

In federal matching Medicaid funds North Carolina will lose $2.7 billion over the next five years. This will shift the cost of these important services back to the State.

The proposed rules will drastically cut Medicaid funding for case management services that provide adults and children with long term supports, social, medical, educational and other services including serious reductions in services provided by our teaching hospitals.

Our State is currently struggling to stabelize our Mental Health, Developmental Disability, Substance Abuse service system.  These changes will undermine those efforts.

According to the House of Representatives study we have this break down of how many services will be affected in North Carolina: 

• Cost to North Carolina if moratorium fails

o Public Providers (CMS 2258-FC)
• Loss of federal funds in 2008 $430.6 million
• Over five years: $2,187 million
• Loss of funding affects State hospital care for Medicaid and indigent recipients

o Graduate Medical Education (CMS 2279-P)
• Loss of federal funds in 2008 $84 million
• Over five years $420 million
• Teaching hospital funding would be in jeopardy
• Service to Medicaid recipients would be affected

o Provider Taxes (CMS 2275-P)
• Loss of federal funds in 2008: Not Specified
• Over five years: Not Specified
• Reduction or elimination of assessments impedes access to care by Medicaid recipients in nursing facilities and intermediate care facilities for MR clients.

o Coverage of Rehabilitative Services (CMS 2261-P)
• Loss of federal funds 2008: Not Specified
• Over five years: Not Specified
• “Unable to adequately project fiscal impact due to interpretation of how this regulation would be applied, anticipate negative impact”

o Payments for School Administrative/Transportation Services (CMS 2287-P)
• Loss of federal funds in 2008: Not Specified
• Over five years: $56 million
• “North Carolina Public Schools utilize funds from School Based Administrative claiming to ensure vital services and equipment for students with disabilities”

o Targeted Case Management (CMS 2237-IFC)
• Loss of federal funds in 2008: Not Specified
• Over 5 years: Not specified
• Providers will only be paid for transitional case management services when the person successfully transitions into the community. This rule can be a financial hardship on service providers who do not have a financial capacity to wait for a reimbursement. Sometimes a transition is not successful for various reasons such as the availability of appropriate support services. In this case if the persons transition is not successful the provider will not receive reimbursement, again creating a financial hardship for the provider.

o Rehabilitative Services Option
• Over five years $2.3 billion
• Rule change will eliminate day habilitation programs and other Habilitation through the option
• Serve people with developmental and cognitive disabilities
• Option provides developmental skills training, behavior development, communication development, sensorimotor development
• Rehab Option/School Based Admin/Transportation are under moratorium until June 30, 2008.

It's not to late to take action to stop these rules from going into effect.  Here is how to get involved this morning:

Call Your Congressional Representative Today

Tell Them to Support H.R. 5613, Protecting the Medicaid Safety Net Act of 2008
Contact your Representative today and urge them to support this important legislation. This legislation is expected to be on the House floor either tomorrow April 22 or Wednesday April 23. The time to act is now.

North Carolina Connection
Representative David Price, Representative G.K. Butterfield and Representative Brad Miller are both co sponsors of H.R. 5613 Protecting the Medicaid Safety Net Act of 2008. We thank them for their leadership.

This legislation will postpone Center for Medicare and Medicaid Rules that negatively affect people with developmental and cognitive disabilities. H.R. 5613 will postpone enactment of these rules until April 2009.

Tell Them
These harmful Medicaid regulations include a rehabilitation option, school-based administration/transportation and targeted case management regulations.

These regulations will severely affect North Carolinians with developmental disabilities.

Many of these rules go beyond the intent of the Deficit Reduction Act.

These regulations will hurt the state of North Carolina financially.

North Carolina will lose $2.7 billion over the next five years in Medicaid reimbursements.

Contact Your Representative Today

Read More: 
Chris Fitzsimon-NC Policy Watch-Highlighted this issue yesterday in his daily Fitzsimon File.
Playing politics with Medicaid

1 comment:

Lynda said...

Basics This is specifically on
my work as a Disability Advocate. I am working with mental health clients. They wrote very effective letters to Republican Senator Arlen Spector PA. He was chosen because the clients live in Phila,PA. The other senator Democrat Robert Casey wasn't written to since we presumed being a Democrat he'd be for HR 5613. The letters told of how their intensive case managers (ICMs) are crucial.
Introduction: Working with mental health consumers to help stop budget cuts to ICM services.

General Abstract: Being a co facilitator with the director of a local disability rehab program I helped facilitate some mental health consumers to write letters to their local congress person. The correspondence were two fold. They wrote how their intensive case managers's services were definitely needed. Plus they strongly suggested cutting programs that let ICMs be of help would be rather harmful to their recovery, support.

Please note HR Bill 5613 deal with other major issues that effect people on Medicaid. Every one of them are equally important. However I want my report to be specific. I am only dealing with the section that deals with intensive case management. I want my writing to be a lot on a specific part of the bill as opposed to a little on the entire bill.

Definitions: Mental Health Consumer. A phrase coined by National Alliance for the Mentally Ill NAMI is the largest family and consumer run organization in the US. It technically means someone who consumes mental health services be it voluntary or involuntary. People in the mental health system who are critical of it, call themselves Psychiatric Survivors. A good site to check out for more info is They are anti forced treatment, drugging. Intensive Case Manager. An ICM is a man or woman, usually an MSW (Master of Social Work) who helps her or his mental health consumer client navigate the mental health system. They help his or her client obtain the services they need too.

John Dingell (D-MI) and Timothy Murphy (R-PA) introduced this bill to delay the start of seven Medicaid regulations that would drastically reduce coverage of services and supports needed for many people with mental illnesses.

The "Protecting the Medicaid Safety Net Act of 2008" (H.R. 5613), would prolong until April 1, 2009, the imposing of the regulatory changes. The bill will be marked up on Wednesday, April 9, by the House Energy and Commerce Subcommittee on Health.

My personal note. I certainly hope April 1st wasn't chosen because its April Fool's Day. Well most likely its merely a coincidence. At least I hope that's what it was.

For the record there are seven specific concerns For the record the reductions include rehab services, school based transportation, outreach.

Our fearless leader George W Bush's rationale is he's balancing the budget. Yes he is balanicing the budget on the backs of the most vulnerable. I strongly suspect he's targeting the most needy because he figures they won't fight back. Well they are fighting back. That is what these letters to local congressmen is all about.

Meanwhile he's spending billions on a war that seems to be going on indefinitely. No matter what one's opinion of the Iraq war is, the fact is because of the fighting there is much less money for domestic social needs. Too bad our president wants to cut the deficit by cutting social spending for the most needy.

It isn't only the organization where I work. The agency is a part of a national wide coalition. We are planning to network with our fellow rehab services throughout the US to join us in implementing fair treatment to people with disabilities, especially psychiatric.

What was done: aka Methodology.

The clients-consumers were urged to write personal correpondences on how their intensive case managers were helping them. Plus they wrote on how much they were needed. The letters were very specific and quite personable. In everyone's writings it was clearly shown how ICMs helped their clients gain the services and support they needed in the community. Perhaps one of the most important reasons for the ICM was they were the direct link between the client and the MH system.

ICMs deal with the nitty-gritty of everyday life for many mental health consumers. They help them navigate how to find housing, gain employment, deal with getting meds or whatever service is needed.

Conclusion. The letters were written. They were edited only for clarity. The women and men who wrote them signed the letters. The next step is networking with other mental health consumers for more impact.

Personal Note. I am quite proud of the clients involved and my personal involvement too. Bush may say he's saving money. However ICMs hel prevent people from going to a psych hospital or psych ward by dealing with people BEFORE they reach a crisis. In other words an ICM prevents hospitalization by eliminating the need to be hospitalized. You don't need to be an economic expert to know being in a hospital for practically any reason is extremely expensive even with coverage. Reducing ICM services is penny wise and pound foolish. I think the letters that were written and sent is a very wise decision.

Outcome: The letters from the agency were mailed and the next step is networking with other groups of the same or quite similar nature. I am very proud of everybody involved.

The letters were mailed to a PA senator Arlen Spector R. We are waiting for his response. The reason it was not sent to Robert Casey D is because we presume he's for the bill. Being that he's a Democrat.

The bill passed the US House of Represenatives by a resounding vote. The danger, problem in the Senate is a proposed Republican filibuster. A filibuster basically means the bill will be talked to exhaustion. There is a very real danger, the bill will not be voted.

Immediately below in the next paragraph is the date and exact voting results of the entire House of Represenatives.

April 23, the whole House of Representatives passed legislation (HR 5613) that would forstall seven newly proposed Medicaid regulations by the Bush presidency. See top of page for more details. The bill passed by a vote of 349-62 – a margin definitely more than adequate to defeat a presidential veto. Source:The National Council for Community Behavorial Health

According to the director of the rehab program if the house bill comes to the Senate floor the bill will pass. However some members of the Republican senators are organizing to block the bill. That is the reason we sent the letters to Senator Arlen Specter R. We are hoping being a somewhat progressive Republican he can help prevent filibuster.

When I get more info I will let people know what that is.

Partial List of National US Disability and Progressive Groups for HR5613 Specially the Campaign for Housing, Health Care etc. includes, communities, networking and much more. Its one of the largest progressive sites on the Internet.

Families USA The Voice for Health Care Consumers.

Mental Health America, formerly National Mental Health Assn.

National Alliance for the Mentally ILL NAMI

National Association of Community Health Centers

People on Wheels. A wheel chair advocacy and support organization.

Many more groups too numerous to mention.

Lynda Appell
Disability Advocate