The Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule with Comment on Medicaid Case Management (CMS-2237-IFC) in the December 4 Federal Register. The rule is slated for implementation on March 3, regardless of comments that question CMS’ authority to develop some of the rules and identify potential harm to individuals if these rules are implemented as written. CMS has no obligation to revise the rules based on comments received. PCPA comments are available. The American Public Human Services Association developed a comparison chart of sections of the rule that exceed the requirements of the Deficit Reduction Act (DRA) of 2005. Legislative action is needed to delay implementation.
Senator Norm Coleman (R-MN) and Representative Keith Ellison have introduced bills (S.2578 and HR 5173, respectively) to block implementation of the rules until April 2009. Please contact your senator and representative to urge their co-sponsorship of these bills.
Some key issues are:
- Case management services are essential to enable access to care and services across a spectrum of needs – mental health, substance use and abuse, mental retardation, aging services, foster care, many complex physical health needs, and more.
- More than one case management provider may be needed to address some of these extremely complex needs. A limitation of one case manager will harm some individuals.
- The estimated cost reductions to Medicaid of $1.28 billion greatly exceed the $760 million estimated in the Deficit Reduction Act of 2005.
- Insufficient time is allowed for preparation for transition to the community with only 60 days allowed for institutional stays of 180 days or longer and only 14 days allowed for stays less than 180 days.
- Insufficient preparation for discharge will lead to destabilization and return to higher acuity services, negating any savings accrued by limiting case management services at the outset.
- The "integral component" requirement will further fragment behavioral health services and tear down relationships that have been effective in serving complex, multi-systemic needs more holistically.
A link to congressional representatives is available through the Legislative Affairs section of the web site. Please contact your congressional representatives today. Contact Anne McHugh Leisure or Betty Simmonds with questions.
