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MR Update #05-12: Provider Council, 2005/06 MR Issues, Dual Eligibles, Altoona Center, and Resources
June 22, 2005

Provider Council
The Office of Mental Retardation (OMR) met with the Provider Council June 17 to address a variety of mental retardation system issues including: PROMISe pilots, consolidated waiver work groups, fee-for-service and rate setting, and system changes. OMR Deputy Secretary Kevin Casey addressed the following:

  • The Consolidated MR Waiver will not be jeopardized and Casey is ready to make difficult and final decisions.
  • Supplemental grant agreements between the state and counties will have to become more contractual.
  • If a county can’t or won’t follow contract requirements, then the state will consider other options such as a separate administrative unit.
  • While the Centers for Medicare and Medicaid Services (CMS) says they are not requiring a fee-for-service system, they seem to be indicating this system to OMR. State rates may be established but will need regional adjustments due to economic cost differences and OMR must find a fair, reasonable, and logical way to set rates and provide an option for increases.
  • Providers are encouraged to do more integrated services. OMR wants to move away from group homes and sheltered workshops.
  • Waiver services may need to be cut or reduced. The state allows much more in the waivers than other states (recreational, habilitation options, etc.).
  • The relevance of Chapter 4300 regulations are in question in a fee-for-service system.
  • Agencies need at least one practice year in fee-for-service to determine if rates set are adequate to maintain services.
  • The Supports Intensity Scale will be a beginning step as an assessment to get a person into the system and it also offers the state an option to try to compare similar costs and services statewide.
  • Interim Dispute Resolution procedures will begin by July 1 with the CMS Work Group addressing final recommendations to begin on July 1, 2006.
  • Provider qualification issues were addressed. Casey wants simple and reasonable requirements which may be included in the Medical Assistance agreement.

Mental Retardation Issues 2005/06
The issues the state’s mental retardation system will be addressing in the next fiscal year (2005/06) and which PCPA will keep members informed include:

  • Consolidated Mental Retardation Waiver and five work groups addressing fee-for-service, services, Supports Intensity Scale assessment tool, provider qualifications, and dispute resolution procedures.
  • Rate setting and negotiations for services in PROMISe pilots and waiver requirements.
  • Continued use and expansion of HCSIS computerization of system.
  • Governor’s proposed Medicaid health care cuts, which the House of Representatives unanimously defeated on June 14.
  • Federal Medicare Part D Prescription Plan selection and impact on consumers.
  • Combining OMR with the Office of Social Programs which has already started.
  • OMR interest in reducing reliance on group homes and sheltered workshops to more integrated services.
  • Federal issues with states' use of assessments to generate additional federal Medicaid matching dollars.
  • Governor’s Office of Health Care Reform grants and inclusion of mental retardation system in long-term care system redesign.

Dual Eligibles
CMS has also released a document, A Strategy for Transitioning Dual Eligibles from Medicaid to Medicare Prescription Drug Coverage. It is available at www.cms.hhs.gov/medicarereform/strategyforduals.pdf. It focuses on six objectives to which CMS is committed:

  • providing comprehensive coverage,
  • eEnsuring continuity of coverage,
  • working with states,
  • eEstablishing appropriate safeguards,
  • protecting special populations, and
  • reaching people with Medicare.

Altoona Center Monitoring
The June 22 meeting of the Altoona Center Monitoring Committee provided details regarding the number of individuals selecting community placement (35), Ebensburg Center (32), and those still undecided (23). Meetings are occurring between providers and families at Altoona and in the community. Currently there are three individuals ready to move into the community in Erie, Philadelphia, and Clearfield/Jefferson counties. Provider service proposals are needed to enable people to move into community settings.

Discussion regarding the proposed state Medical Assistance cuts assured the committee that people will have medical and health care coverage as part of their plan when they leave the state center. For an 18-month period the Health Care Quality Units will do follow-up with each person to assist with medical needs.

Resources
1. Video discs are available to address the state’s Medical Assistance for Workers with Disabilities (MAWD) program. MAWD eliminates the medical insurance barrier to work for persons with significant disabilities that choose work and are eligible for this coverage. For copies of the disc contact Carol Baker, AHEDD and MIG Director (717-763-0968 or carol.baker@ahedd.org).

2. The Supports Intensity Scale (SIS) an assessment planning tool developed by the American Association on Mental Retardation and soon to be used in Pennsylvania has a new web site, www.siswebsite.org that includes an online discussion board for comments and questions.

3. Lives Worth Saving hotline provides people with disabilities with authoritative information on organ transplantation and how to maximize chance for being listed and transplanted (800-637-2316).

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