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CMS Public Forum Overview
August 19, 2004

The federal Centers for Medicare and Medicaid Services (CMS) are conducting public forums across Pennsylvania as part of their review of the state’s Consolidated Waiver for Mental Retardation Services. PCPA staff participated in the August 18 forum in Harrisburg which featured Bill Davis, CMS Regional Director, providing an overview of the Medical Assistance law, federal financial participation, eligibility categories, and service options. CMS provided this opportunity for providers to address the components of the waiver and to make recommendations on the use of the waiver in the state.

Several of the issues presented to CMS included:

  • CMS taking a leadership role on the issue of direct care workforce development initiatives to enhance the quality of services;
  • CMS establishing a policy that allows providers to be reimbursed at a level that allows them to hire and appropriately pay for competent staff;
  • CMS recommendation to state regarding providers reimbursement rates to be more than just for costs, but a negotiated rate that allows the provider to be a business, to have a reserve, and to allow the opportunity for expansion into other counties;
  • CMS needs to require the state to enforce the waiver component that assures the individual receives all the services which they need;
  • Require the Office of Mental Retardation (OMR) to enforce and use the appeal process for consumers and their services and for providers regarding their rates;
  • Require OMR to make the Individual Support Plan available to the provider through HCSIS;
  • Require OMR to develop a single state-developed contract to be used by all counties and providers, and
  • CMS needs to be cautious of requiring the state to make changes per its waiver review that cost the provider money, but without any additional funding to cover these costs. An example is the last CMS review that led to the development of the Incident Management (IM) System. The IM reporting created increased cost to providers for staff time to develop and report. None of these costs were covered by an increase to the provider, therefore it became an unfunded mandate.

Bill Davis, CMS Regional Director, commented as follows:

  • CMS will consider asking the state to develop a unified statewide contract for counties to use with providers which may actually free some counties from some of their administrative burden and allow providers to transition more easily between counties;
  • Providers should be free from county constraints to make business decisions and to negotiate rates appropriate for doing business; and
  • The Department of Public Welfare (DPW) is required to use the 4300 Regulations in the waiver. However, CMS may recommend that these regulations be reviewed, revised, and streamlined.

OMR Deputy Secretary Kevin Casey was in attendance and commented on several of the issues presented:

  • OMR is open to the possibility of a single statewide contract for counties to use with providers;
  • While the 4300 Regulations may actually place a financial burden on the system and providers, it includes regulations for departments other than just OMR and would require review by all components; and
  • With over 9,000 people on the mental retardation waiting list for services and with the prospect of having to serve a broader group of individuals, DPW may have to make a future decision on what they will and will not provide to consumers.

For information regarding CMS or Medicaid access www.cms.hhs.gov. For information regarding the state’s consolidated waiver access www.dpw.state.pa.us. For additional information regarding this session or to share information from the other sessions held across the state, contact Linda Drummond at PCPA.

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