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MR Update #05-08: Volunteers Needed, Medical Assistance Issues, HCSIS Update, Dual Eligibles, and Trainings
May 2, 2005

Volunteers Needed
PCPA is seeking provider volunteers for the following opportunity to work with OMR as a representative of the members of our agency. If you are interested in volunteering, please contact Linda Drummond.

1. Direct Service Staff working in the western and central areas are needed to serve on the OMR Planning Advisory Committee (PAC) which meets five times per year in Harrisburg.

MA Issues
As Pennsylvania struggles with possible cuts to Medical Assistance (MA) services in the FY 2005/06 budget, legislators here and in other states are beginning to look at who receives publicly funded health care. In February, Pennsylvania Representatives Veon and Wheatley began development of legislation that would require an immediate study to determine how many Pennsylvanians employed by large corporations are collecting benefits from the MA program. Lawmakers are becoming concerned that tax payers are essentially subsidizing large companies by paying for health care coverage that the companies should provide.

On April 12, Representative Wheatley introduced House Bill 1336 which would require a public health program employer report for employers that have 20 or more employees receiving Medical Assistance and including the cost to the commonwealth of providing this benefit. Other states have started to study this issue and some have drafted legislation requiring employers to either offer health insurance benefits or contribute to public programs.

  • Arkansas found that nearly 10,000 workers are receiving MA.
  • California found that just one large employer cost the state $32 million in publicly funded MA.
  • Maryland has approved legislation requiring employers with more than 10,000 employees to spend at least 8% of payroll on health care benefits.
  • New Jersey plans to release a similar bill in May.
  • Tennessee is reorganizing its TennCare (MA) because of financial problems.

HCSIS Update
The Office of Mental Retardation will release HCSIS 4.2.3 on May 14 and highlights include:

  • Case comments will now be known as service notes.
  • ISP review data has been added to HCSIS.
  • Provider access to plan functionality added.
  • Case Management Wizard will enable counties to automate the transfer of individuals between counties and Support Coordination entities.
  • The release will be posed on LMS at www.humanservices-r.state.pa.us/HCSISLMS.

Providers will have online access to the Individual Service Plan if the provider has at least one pending, authorized, or pre-authorized service on an approved plan and the Supports Coordinator has designated access to the plan at the support team and individual’s request. For a copy of the update, contact Linda Drummond at PCPA.

Dual Eligibles
The federal Medicare Modernization Act’s Part D Prescription Drug benefit will impact individuals who are low income, elderly, and disabled. If these individuals are currently eligible for Medicaid prescription coverage they will be transitioned as "dual eligibles" to the new Medicare Prescription Drug benefit by January 1, 2006. This creates concerns that the rapid transition will cause a risk of a gap in prescription drug coverage, possibilities that the selected drug insurance plan will not provide the currently prescribed drug, and the need for providers to become knowledgeable on these changes to assist consumers in the enrollment process.

A variety of agencies are trying to address these issues and keep consumers updated. The National Council for Community Behavioral Healthcare has posted information on their web site at www.nccbh.org. The Pennsylvania Health Law Project at www.phlp.org is working with the Department of Public Welfare to address transition of dual eligibles out of HealthChoices. Their web site offers a variety of consumer fact sheets.

The Centers for Medicare and Medicaid Services (CMS) is offering a national Medicare and You training program for state agencies and partners on May 12 - 13 at the Wyndham Philadelphia. For details access www.nmtpworkshops.com.

CMS will start sending notices to dual eligible consumers who are eligible for a subsidy in June, and dual eligibles that will be auto-enrolled will be notified in September. At that time the state Medicaid agencies will send notices to dual eligibles to inform them they will be losing their Medicaid prescription drug coverage and will be enrolled in the Medicare Part D plan.

Workforce Challenges
The Paraprofessional Healthcare Institute has released three publications (available free of charge) that address the high rates of turnover among direct care workers and the cost to the industry and the public. Since long-term care is primarily funded through Medicare and Medicaid, high levels of turnover have significant public costs. Issues addressed include training, on–the-job supports, and wages and benefits. For copies access www.directcareclearinghouse.org.

Trainings

  • Supporting People with Mental Retardation and Sexually Offensive Behaviors available at various locations (Scranton, Harrisburg, Elwyn) on several dates. For details contact Riverside Professional Development, 717-238-3660.
  • Pennsylvania Training Partnership for People with Disabilities and Families offer two-hour trainings addressing "Understanding the Mental Retardation System" and "MR Waiver Basics." For details contact Janet Brouse at 866-283-0174.
  • June 14-15: National Leadership Summit on Secondary Education and Transition at Capitol Hilton, Washington, DC. For details access www.ncset.org/summit05.
  • June 16-17: National Rehabilitation Transition Conference: From Roots to Wings addresses guiding youth with disabilities to employment. For details access www.dtiassociates.com/rsatransitions.

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