Public comment on Home and Community Based Services

The Centers for Medicare & Medicaid Services have issued a Notice of Proposed Rulemaking that would revise the regulations implementing Medicaid Home and Community Based Services (HCBS) under section 1915(c) of the Social Security Act. There are several proposed changes including the following:

· Requirement for person-centered planning

· Characteristics of home and community based settings

· Options for States to combine target groups into a single waiver

· Clarification of timing and public input requirements for amendments.

Please take a few minutes and comment on this important proposed rule.

Click the following link to view the proposed rule and make a comments:

http://www.hhs.gov/od/community/public/index.html

COMMENTS ARE DUE 5:00 PM EST JUNE 14, 2011



The Partnership for Patients and the Aging Network

Message from the Assistant Secretary for Aging Kathy Greenlee

Today, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national public-private partnership with the goals of:

* Keeping patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 

* Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

Through the Community-based Care Transition Program, HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help people with Medicare safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits. In addition, in coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. 

The aging network – state and local organizations alike -- has a vital role to play in this effort to integrate medical and long-term supports and services and improve care transitions for our clients and their families.  This work also provide an excellent opportunity to integrate other important work you are already doing – including Aging and Disability Resource Centers, benefits outreach and enrollment, caregiving and respite programs, chronic disease self-management and other health promotion/disease prevention programs, and more.  Finally, the partnerships that you build through care transitions work – with hospitals, physician practices, long-term care facilities and other organizations – can also help to position you better for future ACA-related opportunities such as accountable care organizations, health homes, patient-centered medical homes, and more.

Here is how we can work together on this initiative:

* Learn more about the Partnership for Patients and join the partnership by visiting the Partnership website at http://www.healthcare.gov/center/programs/partnership 

* Read our special Affordable Care Act Newsletter which provides you with additional details about the Partnership for Patients and the Community-based Care Transition Program (CCTP).  To access the newsletter, please go to  http://www.aoa.gov/Aging_Statistics/docs/ACA_Enews_P4P_041211.pdf 

* Join us for our next Webinar on Wednesday, April 20, which will offer an overview of the CCTP solicitation, and the opportunities for the aging network that lie within.  (Watch your email for registration details)    

Money Follows the Person: A 2010 Snapshot

With the passage of health reform, the Money Follows the Person (MFP) demonstration grant program was extended five years through 2016 giving states further options to transition Medicaid beneficiaries living in institutions back to the community. Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the MFP demonstration provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting. Twenty-nine states and DC are currently participating in this demonstration program and more states plan to apply for MFP grants in the coming year. In July 2010, the Kaiser Commission on Medicaid and the Uninsured (KCMU) surveyed states about the current status of their MFP program including trends in enrollment, services and per capita spending. This year’s survey is a follow-up to the 2008 KCMU MFP survey and highlights findings based on responses from twentysix states.

Key Findings:

More

CMS Proposed Community First Choice Rule

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On February 25th, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule in the Federal Register to implement a new Community First Choice Option.  Under Section 2401 of the Affordable Care Act, this proposed rule establishes a new State option to provide home and community-based attendant services and supports through a new section of 1915 (k) to the Social Security Act.  The goal of this new option is to give States additional resources to make community living a first choice.

Starting in October, this option will allow States to receive a six percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.  Over the next three years—through 2014—States could see a total of $3.7 billion in new funds to provide these services.  Under this new option, States will provide consumer controlled, person-centered home and community-based attendant supports to individuals on a statewide basis.  The person-directed plans and services will be developed in a manner that is most integrated and appropriate to the individual’s needs, without regard to age, type or nature of disability, severity of disability, or form of home and community-based attendant services and supports the individual requires in order to lead an independent life. 

To find out more about the Community First Choice option and to review the proposed rule implementing this section, please visit: http://www.gpo.gov/fdsys/pkg/FR-2011-02-25/pdf/2011-3946.pdf

Comments for this proposed rule are due to CMS by April 26, 2011. 

Immigration Reform: A Key Retirement Issue - The Best Life (usnews.com)

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By Philip Moeller

With Social Security and Medicare programs facing deficit-cutting proposals in the new Congress, seniors and their advocacy groups already have big issues on their plates. Yet a good case can be made that immigration reform is another emerging issue for millions of seniors who need care. The shifting outlook has several components—rising demand for care due to a growing elderly population, a sustained effort to provide elder care in homes rather than institutions, a shrinking work force of Americans, and an economic recovery that will eventually reduce the supply of family members available to provide unpaid care.

Full Article

Sebelius Vows To Ensure CLASS Program Is Financially Viable - Kaiser Health News

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By Marilyn Werber Serafini

The Obama administration is working aggressively to fend off critics of the CLASS Act, a voluntary insurance program created by the new health law to help individuals who require long-term care remain in the community. Health and Human Services Secretary Kathleen Sebelius today promised to pursue changes to ensure the program is financially self-sustaining into the future.

The Community Living Assistance Services and Support Act, to be run by HHS, would provide cash benefits that could be used for a variety of non-medical expenses, such as paying for a home health aide or a family member who provides care, modifications to a home and special transportation needs.

Full Article

AARP: CLASS Program Gives Americans New Option to Plan for Long-Term Care

AARP Executive Vice President John Rother released this statement following today’s remarks by Health and Human Services Secretary Kathleen Sebelius on the Community Living Assistance Services and Supports (CLASS) program, a voluntary insurance option for long-term services and supports created in the Affordable Care Act:

“American families are struggling with the staggering cost of long-term care while state governments look to reduce costs in their Medicaid programs—the largest payers of long-term care.  The CLASS program created by the Affordable Care Act gives Americans a new option to plan for the cost of long-term services and supports through a voluntary insurance program.  At the same time, the program will help take some of the burden off of Medicaid over time as more people are able to plan and pay for their own care.

“We know that 86 percent of our members want to live in their homes for as long as possible, yet too few are able to get the services they need to continue living independently.  The CLASS program can help offer peace of mind to American families and help cover some of the costs of services and supports they need to live independently in their homes and communities.  AARP is committed to giving our members and all older Americans the information they need in the coming months and years to decide if CLASS is right for them.”

Money Follows the Person: A 2010 Snapshot - Kaiser Family Foundation

With the passage of health reform, the Money Follows the Person (MFP) demonstration grant program was extended five years through 2016 giving states further options to transition Medicaid beneficiaries living in institutions back to the community. Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the MFP demonstration provides states with enhanced federal matching funds for twelve months for each Medicaid beneficiary transitioned from an institutional setting to a community-based setting.

Twenty-nine states and DC are currently participating in this demonstration program and more states plan to apply for MFP grants in the coming year. In July 2010, the Kaiser Commission on Medicaid and the Uninsured (KCMU) surveyed states about the current status of their MFP program including trends in enrollment, services and per capita spending. This year’s survey is a follow-up to the 2008 KCMU MFP survey and highlights findings based on responses from 26 states.

Snapshot (.pdf)
Previous version:
June 2009 (.pdf)

Related:

Case Study: Ohio's Money Follows the Person Demonstration (HOME Choice)

Profiles: Money Follows the Person Transitions Individuals from Nursing Homes to the Community

Information provided by the Kaiser Commission on Medicaid and the Uninsured
Publication Number: 8142
Publish Date: 2011-02-07

Money Follows the Person: A 2010 Snapshot - Kaiser Family Foundation

Europe's eHealth Solutions Grow with Aging Population

As the baby boom population in Europe ages, there is a growing demand for eHealth products and services. In the European Union, eHealth technology is already worth 15 billion euro and Brussels is now trying to work on legislation that will make it easier to implement in the coming years, according to EurActiv.com.

Currently, there are a number of telehealth projects that help reduce the duration of a patient's hospital stay by providing an in-home care solution. These include Holland's diabeticStation and Italy's MyDoctor@home service.

Full Article

Updated: Procedures for Implementing Veteran Directed Home and Community Based Services

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The VD-HCBS program provides veterans the opportunity to receive home and community-based services that enable them to avoid institutionalization and continue to live in their homes and communities. The Procedures for Implementing Veteran Directed Home and Community-Based Services describes requirements and procedures for implementing VD-HCBS locally.

CHOICES – Tennessee Long Term Care Services Program

In June 2008, Tennessee passed legislation restructuring LTC service delivery, including the expansion of HCBS services by integrating LTC within a managed care environment and providing consumer direction options. In March 2010, the state implemented the CHOICES program, wherein persons enrolled in TennCare that needed LTC services would receive them through a managed care organization. Review a presentation given at the 2010 HCBS conference and the CHOICES website.

PowerPoint Presentation

TennCare Choices Web Site

Marki Flannery: Home Health Aides: On the Front Lines of Caregiving

by Marki Flannery

Although home health aides provide assistance with all the "stuff" of daily life, the job of a home health aide cannot and should not be done by just anybody -- contrary to all-too-popular belief. Trained home health aides are highly skilled, compassionate caregivers; every day they man the vital front lines of healthcare for vulnerable seniors and others who are not stable enough to be on their own. These talented aides are the best offense for keeping at-risk individuals out of the hospital and living safely and as comfortably as possible in their own homes.

A good home health aide knows that daily activities -- bathing, dressing, eating, sleeping -- are really barometers of health. Subtle changes may indicate deteriorating health or issues with medication.

• If a patient is eating less or sleeping more than usual, do medications or dosages need adjusting?
• If the patient did not previously need help dressing and now does, has his or her condition degenerated?
• If a patient is refusing to bathe, are there emotional issues that need addressing?

A well-trained home health aide is much more likely to notice changes in a patient's behavior or well-being and act immediately and appropriately.
Full Article

More Veterans To Receive Options for Living Independently Under New VHA Partnership with National Resource Center for Participant-Directed Services - RWJF

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Veterans of all ages with disabilities will gain additional support in 28 states under a new program designed to help them live independently, with more choice and control over the services they receive in their homes. Through a contract with the Veterans Health Administration (VHA), the National Resource Center for Participant-Directed Services (NRCPDS) will provide training and assistance to VA Medical Centers that are implementing participant-directed services for Veterans.

In 2008, the U.S. Administration on Aging’s Community Living Program partnered with VHA to create the Veteran Directed Home and Community-Based Services (VD-HCBS) Program. The Program allows Veterans of all ages to have more control over services provided in their homes to allow them to continue to live independently in their communities. Veterans enrolled in the program can manage their own flexible spending budgets, decide for themselves what mix of goods and services can best meet their needs, hire and supervise their own workers, including family and friends, and purchase items or services that help them live more independently. We call this approach "participant direction."

The NRCPDS at Boston College is the only national center of its kind that helps people of all ages and disabilities get the support they need to live as independently as possible. The Center provides research, policy, training and assistance for participant-directed programs. In addition, NRCPDS has a National Participant Network that works with these programs to ensure that they are designed and implemented with the needs and preferences of the individual at their core. The Center will offer a wide variety of training and technical assistance to staff at VA Medical Centers for the benefit of Veterans in the VD-HCBS Programs.

Full Article

Trained Capuchin Monkeys Assist People with Disabilities | Wheelchair Accessibility Blog and Disability News

by Destiny in the Disability News

Specifically trained Capuchin Monkeys are used as aids for people who are physically disabled. They are specially trained to help with housework that might be difficult for a person with disabilities such as removing garbage, fetching the telephone, or switching on the microwave. The Capuchin monkey has small hands with slim fingers making it quite easy to open bottles, grab the telephone, and many other useful tasks. They can also be cute little buddies that help avoid loneliness by providing their companionship.

Continue Reading

HCBS / More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

Summary

To provide a look at the various provisions of the new health reform law on LTC, a distinguished panel of experts addressed questions such as: What are the provisions of the law pertaining to LTC? How will consumers, providers and states be affected? What are the major components of the CLASS Act, and what are some of the challenges for states and the federal government in implementation? Access the presentations, transcript, event summary, podcast and more.

Author

Bosstick, Suzanne; Akins, Tom; Lamphere, JoAnn

Available Files

• Briefing Off-site link

Speakers

Ed Howard, Alliance for Health Reform, Moderator Diane Rowland, Kaiser Family Foundation, Moderator  Richard Frank, U.S. Dept. of Health and Human Services, Speaker  Suzanne Bosstik, Centers for Medicare and Medicaid Services, Speaker  Tom Akins, N.C. Assoc. of Non-Profit Homes for the Aging, Speaker  JoAnne Lamphere, AARP, Speaker (Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law (Word Document), 10/1/2010 Full Webcast/Podcast: More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Suzanne Bosstick (PowerPoint), 10/1/2010 Tom Akins (PowerPoint), 10/1/2010 JoAnn Lamphere (PowerPoint), 10/1/2010 (If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

HCBS / More Info:Caregivers of Veterans – Serving on the Homefront

Summary

While caregivers of veterans face similar situations as family caregivers in general, they also have unique challenges. The study reveals how providing care affects these caregivers’ lives, what organizations and information sources have been helpful to them, and what programs and services would support and assist them. Attached are links to the Full Report, Executive Summary in English and Spanish, Press Release, and a Key Findings Fact Sheet.

Available Files

• Full Report PDF (1,224K, 84 pages)
• Executive Summary-English PDF (548K, 20 pages)
• Executive Summary-Spanish PDF (799K, 20 pages)
• Key Findings PDF (38K, 3 pages)
• Press Release PDF (137K, 4 pages)
• Website Off-site link

HCBS / More Info:Advancing Integrated Employment Outcomes through HCBS Waiver Services: Briefing Document on Section 1915(c) Medicaid Waiver Service Definitions

Summary

Service definitions that focus on employment outcomes are an important component in communicating expectations and building system capacity to increase opportunities for people receiving HCBS services to participate in the general workforce. This document contains the State Employment Leadership Network’s recommendations to CMS on service definitions and related issues that reflect current practice in reinforcing a strong focus on integrated employment.

Available Files

• Brief PDF (267K, 8 pages)
• Brief Off-site link (8 pages)

HCBS / More Info:Achieving Better Chronic Care at Lower Costs Across the Health Care Continuum for Older Americans

Summary

A conference was held to inform potential solutions to improve the cost and quality of care across the health care continuum for older Americans. Synthesizing the conference, this report addresses many of the challenges facing individuals with chronic conditions and functional impairments, and identifies new opportunities for the integration of medical services and social supports tailored to older Americans and supported by new payment designs.

Available Files

• Report PDF (723K, 14 pages)
• Report Off-site link (14 pages)

IRS Releases New Schedule R for Fiscal/Employer Agents

Schedule R for Form 940 is specifically required for "section 3504 Agents acting on behalf of home care service recipients" (more commonly, Fiscal/Employer Agents serving employers in participant direction programs). The purpose of the Schedule R for Form 940 is to allocate the aggregate information reported on Form 940 to each home care service recipient client (participant direction employer). Fiscal/Employer Agents serving participant direction employers in 2010 must complete and submit a Schedule R with the 2010 Form 940, Employer's Annual Federal Unemployment (FUTA) Tax Return. This requirement applies to both Vendor and Government Fiscal/Employer Agents.

The IRS is expected to release a "Stakeholder Partners' Headliner" announcing the Schedule R for Form 940 very soon. For more information, follow the National Resource Center for Particpant-Directed Services (NRCPDS) on Facebook for updates.

The Center for Participant-Directed Services is aware of a free tool to support Fiscal/Employer Agents' completion of Schedule R for Form 940. 941RExpress, a product of Annkissam, will be updated by December 18 to support Schedule R for Form 940 (in addition to the current support of Schedule R for Form 941). Check 941RExpress.com on or after December 18, 2010 for more information about using the free tool.

Click here for the form.

HCBS Reductions? What Advocates Can Do

Steve Gold's Information Bulletin # 324  (9/2010)

Has your State threatened to cut back or reduce Medicaid-funded home and community-based services ?  Has your State actually reduced HCBS Medicaid services?  What impact will these reductions have on people remaining in the community?

What can advocates do about these reductions?  What should CMS do? In addition to how the ADA and integration will be impacted if the reductions are implemented, another handle is the Medicaid statute itself?

To receive federal Medicaid funds, a State must have a written state plan that has been submitted to and approved by the Secretary of the U.S. Dept of Health and Human Services.  CMS posts state MA plans and amendments at www.cms.gov/medicaid/stateplans/

State MA plans must be amended to reflect changes in federal policy, Court decisions, and "material changes" in policy, state law, or operation of the program. 42 Code of Federal Regulations ' 430.12.  Proposed State plan amendments must be submitted to the CMS regional office which must "consult with central office staff on questions regarding application of Federal policy." 42 C.F.R ' 430.14.  CMS must make a "determination as to whether State plans (including plan amendments and administrative practice under the plans) originally meet or continue to meet the requirements for approval are based on relevant Federal statutes [including the ADA] and regulations."  42 C.F.R ' 430.15.

Hmmm.  The United States Supreme Court in 1999 in the Olmstead decision found that unnecessary segregation in institutions violated the ADA - sure sounds like a Court decision.  CMS has issued several "Dear State Medicaid Director" letters telling states that their State plans must comply with both the Medicaid and the ADA statutes, and these letters sure look like federal policy. Therefore, when your State proposes reductions in HCBS, advocates must analyze what impact the reductions will have on causing or preventing unnecessary segregation. 

Advocates must ensure that CMS will disapprove the amendments based on Olmstead and its own policy requiring compliance with the ADA.

Advocates for older and younger Americans with disabilities should:

1.  Find out if your Governor has reviewed the proposed amendments, a Medicaid requirement for State plan amendments?

2. Contact your regional CMS officials and obtain copies of documents between your State and CMS regarding the amendment.

3. Unbelievably, there is no requirement for public hearing or even an opportunity for public comment.  Nevertheless, each State has a Medical   Care Advisory Committee that reviews and comments on proposed changes.    Get to them and make your voices heard.

4.  Send your comments to the CMS regional office AND to the Secretary of   HHS.  Tell them how the amendments will impact on people unnecessarily   being institutionalized.

Thanks very much to the National Health Law Program for their invaluable suggestions and observations, many of which are the basis for and incorporated in this Information Bulletin.

Steve Gold, The Disability Odyssey continues

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

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