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Mental Retardation Update #04-05
February 17, 2004

Confrontation over Medicaid Financing
The February 16 edition of the New York Times ran an article “US Nears Clash with Governors over Medicaid Cost” that addresses a possible confrontation between the Bush Administration and the states over financing of Medicaid. Federal officials contend that states use creative bookkeeping and other ploys to obtain large amounts of federal Medicaid money without paying their share. Medicaid costs are split between the federal government paying 50-70% and states paying the difference.

State officials acknowledge their desire to make the most of federal Medicaid payments at a time when health costs are soaring. The National Conference of State Legislatures advises its members on “Medicaid maximization” strategies and says such techniques are legitimate and desperately needed to avoid cutting benefits to individuals.

The General Accounting Office, an investigative arm of Congress, recently added Medicaid to its list of high-risk programs. In some cases, it said, states have created the illusion that they have made large Medicaid payments to county hospitals and nursing homes and they claimed federal Medicaid money to help defray the costs, even as they required counties to return most of the money to the state. Federal investigators have found such practices in Alabama, Illinois, Michigan, Nebraska, North Carolina, Pennsylvania, and Washington.

For a copy of the entire article, access www.nytimes.com/2004/02/16/politics/16MEDI.html?hp.

PA State Budget
The Office of Mental Retardation (OMR) has not yet scheduled its 2004-05 FY budget review meeting so there is limited information available on this budget proposal. The community mental retardation budget includes $8,574,000 in state funds combined with additional federal funds for a Waiting List Initiative. This approximately $15 million is expected to provide home and community based services to 531 people for six months. This includes 325 people in the Consolidated Waiver, 150 in the Person/Family Directed Supports Waiver, and 56 young people “aging out” of the Early Periodic Screening, Diagnosis and Treatment Program. It will also fund 12 additional Supports Coordinators.

The budget is based on the assumption that the legislature will pass legislation to create an ICF/MR assessment. This planned tax of approximately 6% on state and private ICF/MR beds would operate like the nursing home tax passed last year, to generate additional federal matching funds for the program. If passed there would be $17 million raised by the assessment that would generate (with federal match) about $34 million for OMR.

There are no cost of living (COLA) increases for community programs. There is no Recruitment and Retention initiative. To comply with regulations, ICF/MRs receive a 2% per-diem increase.

Increased state funds are included to provide Early Intervention services to an additional 1,000 children from birth to age 3.

Human Services Development Fund (HSDF), which was originally reduced in the current year’s budget then restored to 90%, will have the addition of Intergovernmental Transfer funds and be level-funded for 2004-05 at $36.8 million. HSDF is block granted to counties for many uses including transportation, homemaker service, personal care, drug and alcohol treatment, mental health, and mental retardation programs.

HCSIS
HCSIS Release 3.2.2 will go live on February 21. This includes several changes to the Individual Support Plan (ISP) to allow daily batch process to update the service rates and the ability to create and submit an annual review plan after the plan end date. There will be a new IM4Q printable survey summary. DPW is in the process of modifying the security on HCSIS. One aspect is to clean the user database. In the next few weeks, HCSIS staff will be contacting users to request corrections on existing user accounts or to supply missing data. Primary data requested will include email addresses and/or telephone numbers. At no time will passwords be requested.

Incident Management
The February 5 OMR Incident Management Template Meeting offered an opportunity for OMR staff, counties, and providers to address the quarterly management report and the various forms (Common Factors Checklist; Sequence Analysis; Fundamental Incident Review and Analysis) developed as tools to assist in collecting and reporting incidents. The final MR Bulletin on Incident Management is scheduled for release on February 21. It has been signed by Secretary Richman and forwarded for inclusion in the Pennsylvania Bulletin.

Since the inception of the HCSIS Incident Management reporting on January 4, there have been:

  • 5271 Incidents reported (678 restraints; 878 medication errors);
  • 907 Optional reportable events;
  • 2630 Individual and site incidents; and
  • 165 Finalized provider investigations.

Project Access
Project Access is a housing voucher program designed to assist low income people with disabilities under the age of 62 who wish to move out of nursing homes into privately owned housing in any community in Pennsylvania. The Housing and Redevelopment Authority of the County of Dauphin is administering this project. For details contact Gail Hoffmann, Self Determination Housing Project at 215-884-2091 or Betsy Rios, Dauphin County Housing at 717-939-9301 Ext. 526.

Homeless Assistance Grant
The PA Department of Community and Economic Development and the Department of Public Welfare (DPW) are coordinating the PA Regional Homeless Assistance Process. This process enables homeless housing and service providers from the rural areas of the state to apply for Housing and Urban Development (HUD) McKinney-Vento funding. HUD’s priority will be permanent housing projects for chronically homeless individuals with disabilities. For details on responding to the March 1 Notice of Intent to Apply, contact Diana Meyers and Associations, 6 South Easton Rd., Glenside, PA 19038 or 215-576-1150 or PARHAP2004@hotmail.com.

Federal Audit
An audit by the Office of the Inspector General of the federal Department of Health and Human Services (HHS) of Pennsylvania’s Medicaid Behavioral HealthChoices program found that some counties made unreasonably high “profits” on the program. The auditors indicated that the profits meant money remaining after counties had paid for direct Medicaid behavioral-health services were greater than 10%, including one county with a profit of 38%. DPW has stated that no problem exists with the current HealthChoices system and in a response to the audit indicates that HHS has no authority to set profit limits in individual counties. Many counties have used their profits to provide extra services for individuals. For additional information contact Ben St. John, Office of Inspector General, HHS, 202-619-1343 or paffairs.oig.hhs.gov or Stephanie Suran, DPW Press Office, 717-787-4592, or ssuran@dpw.state.pa.us.

Special Kids Network
Special Kids Network now offers an online searchable database of resources for children with special healthcare needs and their families. Contact the Help line at 800-986-4550 or www.health.state.pa.us/skn.

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