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MR Update #05-16: Death Penalty, Federal Issues, Medicaid Commission and Senate Hearings, PUNS/SIS Work Group, Draft MR Bulletins, HCSIS Update, and Resources
August 2, 2005

Atkins and the Death Penalty
The defendant in the Supreme Court decision Atkins v. Virginia, Daryl Atkins, age 27, is on trial again in Virginia as he tries to prove that he is mentally retarded. This was the Supreme Court case in 2002 that barred as unconstitutionally cruel the execution of persons with mental retardation. However, the Supreme Court did not provide guidance on the definition of mental retardation so that must be decided by the state court. Virginia law requires that mental retardation be determined by the age of 18 and Atkins did not have his IQ tested as a youth. In 1998 he scored 59 on an IQ test, but recently tested 74 and 76.

Federal Issues

  • On July 29 members of the Senate Finance Committee introduced the"Improving Long-term Care Choices Act" (S.1602) that includes a provision for states to have the option of providing home and community-based services as part of their state Medicaid Plan. Some states do not offer this option.
  • The Centers for Medicare and Medicaid (CMS) released its Quality Improvement Roadmap to assist in ensuring the right care for every person. Copies are available at www.cms.hhs.gov/quality/quality%20roadmap.pdf.
  • The House of Representatives has passed all 11 of its appropriations bills. The Senate has only completed 6 of its 12 appropriations bills and is not due back in session until after Labor Day.
  • Key disability program funding for FY 2006 include cuts in the Supported Employment State Grant program by $8 million and restoration of the HUD Section 811 Assistive Housing program.

Federal Medicaid Commission
The newly developed federal Medicaid Commission held its first meeting July 27 with a goal of determining how to generate $10 billion in savings over five years to the Medicaid program. Many of the commissioners raised the importance of guaranteeing health care coverage to children, others addressed the need for people to purchase long-term care insurance offered by private insurance plans, and others raised the importance of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program which is currently a mandatory Medicaid benefit.

Disability advocates in attendance refuted the commission’s notion that Medicaid beneficiaries could obtain health and private, long-term care insurance, since those with disabilities have very complex needs that cannot be met in the private market. Also, affordability and pre-existing conditions are factors preventing these individuals from obtaining this kind of insurance. They also requested that EPSDT remain a mandatory benefit since investing in children could save money by allowing them to maximize their development and education while minimizing the need for life long services.

US Senate Committee on Finance
On June 28 - 29, the US Senate Committee on Finance held hearings entitled
"Medicaid Waste, Fraud, and Abuse: Threatening the Health Care Safety Net.” More than 53 million Americans depend on Medicaid for their health care; it covers two of five births, one in four children, and 40 percent of all long-term care services.

Finance Committee member, Senator Max Baucus (Montana) stated that Medicaid costs are growing due to increased enrollment, rising cost of long-term care, and health care inflation.
However, it also needs to correct some of the inconsistencies such as inflated pharmacy payments, improper asset transfers, or questionable state financing methods. States need to know the rules of financing arrangements upfront and they must be judged by consistent standards.

OMR Waiver Work Groups
The Office of Mental Retardation’s (OMR) Assessment Work Group addressing federal concerns regarding the consolidated mental retardation waiver has developed two sub-work groups. One will address Priority and Urgency of Need for Services (PUNS) and the other will address the assessment tool, Supports Intensity Scale Plus (SIS).

Comments Due to OMR
The Office of Mental Retardation (OMR) has released several draft Mental Retardation bulletins and dispute resolution protocol for public comment (see list below). For copies of the documents and to have comments included with PCPA’s response, contact Linda Drummond.

  • Service Review Protocol (dispute resolution) procedures with comments due by August 19
  • Certified Investigations draft bulletin with comments due by September 7
  • Provider and County Incident Management Analysis Report draft bulletin with comments due by September 7.


HCSIS Update
The Office of Mental Retardation’s HCSIS project will issue Release 5.1.1 in mid-August. Highlights of this release include:

  • Expansion of individual budget statement extracts.
  • New feature allows the County Mass Rate Change Role to change the rates of a provider’s service throughout all plans in which that service is present.
  • Half-day Incident Management Analysis Report trainings will be available for registration on the Learning Management System (LMS) at www.humanservices-r.state.pa.us/HCSISLMS (*To access material and register for training, a Quality Manager role must be assigned by a local LMS administrator within a provider or county agency);
  • OSP funded services should have all annual reviews completed, if a consumer does not have the annual review submitted and approved in HCSIS no claims can be paid for services delivered after June 30, 2005.
  • For a copy of the HCSIS Update contact Linda Drummond.

Medicare Resources
Several new resources are available for information regarding the federal Medicare Prescription Drug Program.

Housing Resources

  • Pennsylvania (PA) Housing Coordinator Initiative implemented by the Self Determination Housing Project of PA assists in helping persons with disabilities move to accessible and affordable housing of their choice. For information contact Gail Hoffman or Mary Penney at 888-5500-SDHP.
  • Pennsylvania Housing Finance Agency has a new service, PA Affordable Apartment Locator to search for vacancies by county, zip code, or bedrooms. Access www.phfa.org/pal.

Resources

  • Quality Measures 2005, produced by the Council on Quality and Leadership, provides information regarding quality measures and indicators, health and safety assurances, quality of life, and quality improvement initiatives. An overview is available at www.thecouncil.org/misc/cdrom.
  • In the Name of Treatment - a parent’s guide to protecting children from the use of restraint, aversive interventions, and seclusion is available to download from The Alliance to Prevent Restraint, Aversive Interventions, and Seclusion at www.aprais.org.

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