Providers Fear Iowa Cuts

DES MOINES — The state government's plan to privatize Medicaid services includes a new payment system that organizations helping people with physical, mental or developmental disabilities say cuts their reimbursements enough that it could force smaller organizations to close and leave people they serve scrambling to find needed services.

The providers include mental health centers and organizations that serve the most vulnerable adults and children in Iowa who rely on Medicaid for treatment, assisted living, behavioral programming and improving day-to-day living skills. These services often are used by people with brain injuries or those born with physical or intellectual disabilities.

CMS-NYS Making Medicaid More Coordinated, Person-Centered

The Centers for Medicare & Medicaid Services (CMS) announced that CMS is partnering with the New York State Department of Health (NYSDOH) and the Office for People with Developmental Disabilities (OPWDD) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

"We are pleased to partner again with the State of New York to bring more person-centered care to Medicare-Medicaid enrollees," said CMS Tim Engelhardt, Director, CMS Medicare-Medicaid Coordination Office.  "We look forward to working together to provide Medicare-Medicaid enrollees with intellectual and developmental disabilities an opportunity to experience more integrated benefits and coordinated care."

Legal Battle Over Texas Medicaid Cuts

Texas was within eight days of slashing the amount of money it pays therapists for poor and disabled children when a state district judge last month stepped in and blocked the move. It was the latest round in a high-profile legal and public relations battle that has ensued since lawmakers ordered a roughly 25 percent cut in Medicaid funding for pediatric therapy services. The conflict has mostly been cast as a battle between government budget ax wielders and helpless children, and the cuts are now in limbo at least until a January trial date.Meanwhile, the Texas Health and Human Services Commission must figure out a new plan to slash payments to therapists — which Texas officials say are more generous than payments in other states — without closing down the sometimes big businesses that have come to rely on that cash flow to provide care to vulnerable Texans.

Kansans with Disabilities Complaints Prompt Delay in Service Changes

The state said Tuesday that it will delay a major overhaul in the way it provides services for the disabled.

The announcement comes after people with disabilities, their family members, providers and care takers voiced major concerns with the state’s nine-month time line to switch a complex system of care for some of Kansas’ most vulnerable populations.“This is probably the single biggest change this system has seen” in nearly 20 years, said Dee Staudt, director of the Sedgwick County Developmental Disability Organization. In 1995 the state passed a law, guaranteeing certain rights for people with developmental disabilities.

Read more here: http://www.kansas.com/news/local/article38029176.html#storylink=cpy

Texans Sue to Block Medicaid Cuts

A group of home health providers and parents of disabled children has sued the Texas health agency, seeking to block deep cuts in Medicaid therapy payments set to take effect Sept. 1.The cuts would eliminate some $200 million in Medicaid spending on physical, occupational and speech therapy services, as directed by the Legislature in a rider tacked onto an appropriations bill. The cuts would primarily affect care for children with disabilities who require ongoing therapy, but they also could impact adults requiring therapy from injuries or surgery.

Looking to Provide States Incentive for Providing More Opportunities

A bipartisan group of senators is looking to provide financial incentives to states for helping people with disabilities live and work in the community.The lawmakers want to establish a new Medicaid demonstration program that would offer financial bonuses to states for encouraging community-based outcomes. Under a bill introduced this week, a five-year program would be established in 10 states.

Physicians: High Court's Medicaid Ruling Blocks Equal Access

Organized medicine is complaining that a 5-4 decision last week by the Supreme Court unfairly bars healthcare providers from suing state governments over paltry Medicaid rates.

With the door to the courthouse blocked, medical societies contend, there's little if anything they can do to force states to pay enough so that more physicians will accept Medicaid patients, ensuring equal access to care.

California Medicaid Providers Win Battle

SACRAMENTO — A federal judge on Friday barred California from reducing payments for certain Medicaid services for developmentally disabled Californians.
Medicaid providers will not have to comply with a policy forcing them to bill for only half a day when they work for less than 65 percent of the workday.

Minn. Advocates Push for Reform

Thousands of Minnesotans struggling with physical and mental disabilities have been deprived of basic services and therapy because county governments are failing to spend millions of dollars set aside for disability services.

In the past two years alone, nearly $200 million in state and federal money that was allocated by the state for people with disabilities went unspent by counties, state records show. As a result, disabled people were placed on long waiting lists for services and wrongly told that money was unavailable.

The situation has inflamed advocates and state lawmakers, who are now pressing the administration of Gov. Mark Dayton to accelerate long-stalled reforms that would expand access to independent housing, transportation and other services for the disabled.

Parents, Advocates Blast Housing Plan

TRENTON — One parent of a man with autism called it confusing and terrifying. A housing developer of community housing for people with developmental disabilities called it "a misguided social experiment."

Marsha Adams testifies about
 her son who needs 24-hour care.

The Christie administration's sweeping proposal to promote community living and wider access to jobs and activities for the developmentally disabled was roundly criticized at an Assembly hearing at the Statehouse Thursday. Parents, advocates speciality home builders and community agencies said they feared the Department of Human Services' blueprint to spend a large portion of its Medicaid funding could disrupt the living arrangements and daily routines of thousands of people.

Quality Health Care Trumps Volume

The federal government’s drive to reshape health care in America continues to take shape with the latest shift to value-based payment.

The Centers for Medicare and Medicaid Services (CMS) recently set a time line for having half of all Medicare payments based on the value of the care provided, not simply the volume of services. While CMS is often the leader in setting quality and value metrics, health plans have also set pay-for-performance metrics for their policy holders, and, most recently, the New York State Department of Health has set value metrics for Medicaid under the Delivery System Reform Incentive program.

Indiana Expands Medicaid and Charges Beneficiaries a Montly Fee

WASHINGTON — After a lengthy back-and-forth, the Obama administration has agreed to let Gov. Mike Pence of Indiana, a Republican, expand Medicaid on his own terms, including some that have not been allowed before under federal rules.

Indiana Gov. Mike Pence

The plan will extend coverage to an additional 350,000 Indiana residents with incomes of up to 138 percent of the federal poverty level — about $16,100 for a single person and $27,310 for a family of three — starting next month. As in the 27 other states that have expanded Medicaid under the Affordable Care Act, the federal government will cover the entire cost through this year and at least 90 percent in future years.

Editorial: Republican Govs Rethink Obamacare

Tennessee, like most states led by Republican governors, was so adamantly opposed to Obamacare that it rejected the money Washington offered to expand Medicaid coverage.

Now Gov. Bill Haslam is having second thoughts. He has watched several hospitals in his state close down because they could not afford the care they provided to the poor and uninsured. Even the hospitals that survived are taking a hit.

So now the governor is calling a special session of the state’s Legislature in January to reverse course.

Half of Medicaid Providers Not Available to Treat Patients, Report Finds

WASHINGTON — Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report.

“Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday.

Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act.

Rule Makes It Tough to Meet Rising Demand for Long-Term Services

WASHINGTON — For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes. The number of people living in skilled nursing facilities has declined significantly over the past decade, despite a marked increase in the number of elderly in the U.S.Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes — such as assisted living facilities, continuing care retirement communities, group homes and adult day care — work with residents and their families to develop individual care plans specifying the services and setting each resident wants. The overarching goal is to create a “homelike” atmosphere, rather than an institutional one and to give residents choices about their care.

Feds Clarify Autism Coverage Rules

In what advocates are calling a major win, federal officials are for the first time telling states that Medicaid coverage must include treatments like applied behavior analysis for children with autism.

Medicaid programs nationwide must offer “medically necessary diagnostic and treatment services” to kids with autism, the Centers for Medicare and Medicaid Services told states in abulletin this month. That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.

Connecticut Medical Homes Improving Medicaid Care Coordination

The use of nationally certified medical homes to coordinate the care of Connecticut's Medicaid patients has led to improved quality, a 2 percent cut in per person costs, and a 32 percent increase in the number of participating providers during an 18-month period.
The news comes as the state moves forward with plans to jumpstart the medical home movement in Connecticut with an expanded "Glide Path" program that would assist all practices – not just those that accept Medicaid patients – working to become medical homes. The program, still under development, would require practices to meet national standards.

Lawmakers Urged to Fund Developmental Disability Services in Florida

TALLAHASSEE-- .Advocates for people with developmental disabilities Tuesday called on lawmakers to take advantage of Florida's improved economic outlook, slash a waiting list for services and raise hourly wages for caregivers.

The Florida Developmental Disabilities Council and The Arc of Florida said their legislative agenda includes supporting Gov. Rick Scott's budget recommendation of $20 million to reduce a waiting list for home- and community-based services under what is known as a Medicaid "waiver."

The thousands of people on the waiting list have different levels of need, but the Agency for Persons with Disabilities has identified people to serve as quickly as possible because of critical needs.

Feds OK Long-Term Services in KanCare

Kansas officials said they have received formal approval from federal authorities to include long-term services for the developmentally disabled in KanCare.They said they would release later Thursday copies of the signed documents, including so-called "special terms and conditions," spelling out some of the terms of the inclusion, which has been resisted by most of the state's providers of developmental disability services.Gov. Sam Brownback, who launched his administration's Medicaid makeover on Jan. 1, 2013, called the inclusion "an important step forward for KanCare" and the 8,500 developmentally disabled people who receive Medicaid services.

Agencies Challenge New Hampshire's Transition to Medicaid Reform

NASHUA – Clients, parents and employees of Gateways Community Services packed a showdown meeting at Harbor Homes last week on the state’s plans to impose cost efficiencies on a state Medicaid system considered to be hemorrhaging money.

Medicaid officials told the Governor’s Commission on Managed Care that more than 100,000 Medicaid subscribers on Dec. 1 smoothly switched into care management for their visits to hospitals, clinics, doctors and other medical providers.

New Hampshire is the 48th state in the nation to offer managed care under Medicaid and state budget writers are relying on the reform to save $16 million in state spending over the next 22 months