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MR Update #05-22: Rate Setting Training, Medicare Lawsuit, Dual Eligibles, and State Hospital Closure
December 8, 2005

OMR Rate Trainings
The Office of Mental Retardation (OMR) is developing trainings for the new rate setting process and use of new spreadsheets to assist agencies in transitioning from program funding to fee-for-service. Morning and afternoon sessions for counties and providers and evening sessions to orientate consumers and families will be scheduled. Locations and times will be verified by OMR soon. Regional dates will be:

  • Northeast – January 4 and 5;
  • Western – January 10, 11, 12;
  • Southeast – January 17, 19; and
  • Central – January 30, 31.

PCPA is also developing training to be held in February about establishing rates and budgets and ongoing management of the reimbursement process to assist providers in this transition. Watch for details.

Medicare Lawsuit
The Pennsylvania Health Law Project, Community Legal Services of Philadelphia, and several other groups filed a lawsuit the week of November 30 against the Centers for Medicare and Medicaid Services and the US Health and Human Services secretary. The suit asks the courts to block the automatic enrollment of people who receive both Medicare and Medicaid, called dual eligibles, into Medicare managed care plans. Alissa Halperin, managing attorney for the Philadelphia office of the Pennsylvania Health Law Project, has stated that more than 110,000 Pennsylvania’s could be affected by the auto enrollment. This could force some recipients to change doctors or hospitals because Medicare managed care plans generally restrict members to a specific provider network.

Transition for Dual Eligibles
The Centers for Medicare and Medicaid Services has issued a transition plan called “Point of Sale Protection” to allow beneficiaries that visit pharmacies before they have been auto enrolled in a Part D plan to be able to obtain their prescriptions. For details on this plan, access www.cms.hhs.gov and search Point of Sale Protection.

State Hospital Closure
The Office of Mental Health and Substance Abuse Services has announced that the Harrisburg State Hospital will close by the end of January, a month later than originally planned. There are 107 patients currently at the facility; 33 are expected to be transferred to the community. Eighty-seven of the 260 original residents have been transferred to other state hospitals and about five percent were discharged to live independently or with family. Dauphin County has plans to build a 16-bed residential care facility for nonviolent offenders, but construction has not started.

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