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MR #04-19: Enhanced Case Management, Olmstead, ICF Assessment
June 10, 2004

DPW Enhanced Case Management
The Department of Public Welfare (DPW) is initiating primary care case management and disease management in all non-HealthChoices counties effective January 1, 2005. This will be called Enhanced Primary Care Case Management (EPCCM). The Office of Mental Retardation (OMR) will provide training on how to transition to EPCCM prior to the implementation date.

All individuals enrolled in EPCCM will be required to choose a Primary Care Physician (PCP) similar to HealthChoices. It is anticipated that one contractor will enroll the PCPs who are required to be enrolled in Medical Assistance.

Enrollment is as follows:

  • January 1, 2005 mandatory enrollment for all children who are currently enrolled in Medicaid and all children that are dually enrolled in Medicaid and Medicare transferring from the Family Care Network.
  • March 1, 2005 begin enrollment for adults and children not in Family Care. This enrollment includes persons residing in non-public ICF/MRs. Adults that are dually enrolled can choose disease management and not Primary Care Case Management.

Olmstead Planning
The OMR Provider Advisory Council (PAC) Community Integration Subcommittee met on June 8 to begin the planning for the development of the state’s Olmstead Plan. Stakeholders (including PCPA) addressed the various issues, topics, and criteria needed in this plan. Work groups were formed to develop plans based on all aspects of community living in the most integrated, least restrictive environment. The work groups will address guiding principles, public and private ICFs/MR, children, large state funded facilities, other residential facilities, non-residential services, and persons at risk. Each group will also address barriers to implementation of desired outcomes.

PCPA is serving on the Children’s and the Other Residential Facilities Work Groups. Member agencies will be contacted for input on recommendations for implementing Olmstead requirements to offer consumer choices in the most integrated setting possible. One of the first priorities for OMR will be the development of options for 104 individuals currently residing in state mental retardation centers who have requested to move into the community.

PCPA has developed an overview of Olmstead and what Pennsylvania has done so far related to the principles of this Supreme Court decision. If you would like a copy or have any questions, please contact Linda Drummond.

OMR ICF/MR Assessment
The first meeting of the ICF/MR Assessments Implementation Committee was June 3 to address the purpose and issues regarding the development of the state’s law and policy requiring all public and private ICFs/MR to be annually assessed at 6%, the Centers for Medicare and Medicaid Services (CMS) allowable maximum. DPW legal counsel has developed draft legislation that would need to be passed this legislative year to be implemented retroactive to July 1, 2003. Agreements and procedures must be finalized with ICF/MR providers including the basis and calculation of the assessments, timetables, policies and procedures for collecting the assessments, monitoring, and accountability.

The federal government through the House Energy and Commerce Committee’s Health Subcommittee has conducted two hearings regarding the issue of the states uses of intergovernmental transfers and taxes charged to providers as a way to generate more Medicaid matching dollars. The contracted consultants for DPW have assured PCPA that the way Pennsylvania plans to develop their assessment is not in violation of CMS or federal law, policy, or regulations. The proposed legislation would require a broad-based, uniform assessment that will fit into the state’s current plan and doesn’t require CMS approval or a state plan revision or waiver.

DPW is moving rapidly on the “revenue maximization” plan and has requested provider input. PCPA has shared this information and requested assistance from its ICF/MR members.

MA Expenditures
Analysts at MedStat have developed two reports addressing Medicaid (MA) expenditures for long-term services. One addresses expenditures for long-term services including nursing homes and ICF/MR. The other looks at the Section 1915(c) Home and Community Based Waiver program. Spending for these services are now almost one-third of all MA long-term care costs. Three-fourths of waiver expenditures are for people with mental retardation and other developmental disabilities. Reports are available at www.hcbs.org.

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