May 9, 2012
From: Mary K. Short [MaryKShort@aol.com]
Subject: Federal Government changes re Long Term Care
I would like you all to read the information below. I have been following the changes that are talked about. I have been sending you all some information about what is happening at the federal level ... even The Arc put the information about the new Administration on Community Living (ACL) in their Action Alert. On April 17th I sent an email with the press release about the new ACL to Rep. Dollar and Rep. Avila asking them to use that information as a basis for stopping the further implementation of this move to Managed Care! I asked for them to consider the idea of moving IDD to Dept. of Aging or Dept. of Long Term Care because that is the direction the feds are taking. (http://www.hhs.gov/news/press/2012pres/04/20120416a.html.)
The information is from Steve Gold, an ADA attorney in PA, http://www.stevegoldada.com, is clear. Please use this information when you contact your Legislators! This is about NOT moving us to a capitated managed care system.
828-632-5888 or 704-451-4144 (cell)
From: ncadvocacy@yahoogroups.com
Reply-to: notify-dg-ncadvocacy@yahoogroups.com
To: ncadvocacy@yahoogroups.com
Sent: 5/9/2012 6:22:25 A.M. Eastern Daylight Time
Subj: [ncadvocacy] Digest Number 2011
Messages
________________________________________________________________________
1. Fw: [NYAPRS Enews] Gold Urges States to Adopt Community First Choice
Posted by: "lauriecoker"
Date: Tue May 8, 2012 7:18 am ((PDT))
The Centers for Medicare and Medicaid announced this funding program, the "Community First Choice" option, just last week. It is a funding option that would specifically impact our citizens who could live independently with some services rather than being housed in large facility settings such as many of our adult care homes or "assisted living" facilities. It aims to impact states like ours, New York, and others that have become dependent on the convenience of placing people in "homes" -- some of which have 100 plus beds!
New York, which has had a similar ruling by the DOJ to ours about the institutional bias and limiting rightful choices for citizens, is planning to use this to change their behavior.
We could use this to help us in the very near future, but we have to advocate for it!
See some of Steve Gold's strategy suggestions re: this opportunity, below. It may be time to build a cross-disability coalition to bring change.
Please talk to decision-makers about using dollars for services in real community settings so that individuals can envision personal lives with goals and hopes. It costs less to the taxpayer, and surely less to the person who wishes to live differently than in a facility based setting.
Laurie Coker
Director, NC CANSO
North Carolina Consumer Advocacy, Networking, and Support Organization
Citizen self-advocacy and empowerment - State-wide from Winston-Salem
There is no more blessed bondage than to be a prisoner of hope. --R .Z. Kemp
----- Forwarded Message ----
Sent: Tue, May 8, 2012 7:50:39 AM
Subject: [NYAPRS Enews] Gold Urges States to Adopt Community First Choice Programs
NYAPRS Note: New York State officials have already committed to adopting the CFC program, which will also apply to those at risk for residing in what’s called an IMD (institute for mental disease) that includes facilities over 16 beds.
Community First Choice Regulations Published.
Steve Gold May 2012 Information Bulletin # 357
Let's hear the trumpets and the Halleluiahs chorus.
Finally, the Department of Health and Human Services / Centers for Medicare & Medicaid Services issued the final regulations for the Community First Choice option. The regulations state that CFC's scope is designed to make available home and community-based attendant services and supports to eligible individuals, as needed, to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, or cueing.
CMS listed CFC's Total Benefits as providing States with additional flexibility to finance home and community-based services and attendant services and supports. The regulations state that CFC will increase State and local accessibility to services that augment the quality of life for individuals through a person-centered plan of services and various quality assurances. CMS further noted that CFC reduces the financial strain on States and Medicaid participants.
CFC is a win-win for States to save money and for people who need community-based and attendant services to stay in their homes and apartments.
For many years, the Community First Choice was strongly supported and initiated by ADAPT, a national grass roots organization of people with disabilities of all ages and all disabilities. ADAPT organized large numbers of supporters, testified before Congressional committees, and last week demonstrated in front of HHS's Washington offices demanding CMS release CFC's regulations.
Now that the federal regulations have been released, the struggle shifts to you disability and aging advocates in each State - to make sure this program is implemented in your State. Nothing happens automatically. Unless advocates demand CFC state-by-state, it will not happen. Yes, another local effort but quire worth the effort.
Here's why your State should amend its Medicaid Plan to include the CFC the federal government will pay an additional 6 percentages to your State's Federal Medical Assistance percentages. (Go to http://aspe.hhs.gov/health/fmap.htm to see what the FMAP is now WITHOUT the additional six points.) That translates into a LOT of federal money!
Another reason: yes, your State can save a lot of State funds while at the same time complying with the ADA/Olmstead requirements to prevent unnecessary isolation and institutionalization of people with disabilities.
Here's a brief summary of the final regulations:
- CFC provides home and community-based attendant care services and supports to persons with disabilities.
- Such services must assist the individual with activities of daily living, instrumental activities of daily living (e.g., shopping cleaning) and health-related tasks.
- States can provide, at the State's option, transition costs (rent and utility deposits, first months rent/utilities, basic kitchen/bedding needs).
- Individual eligibility requires that the person with a disability meets your State's institutional level of care criteria. The person need not be in the institution nor packing their bags or at risk of being imminently institutionalized. If the person meets the level of care for the institution, the CFC services can be provided.
- Individual financial eligibility is the same as what your State has established for the institution.
- Under the CFC, States must use a person-centered service plan and the services must be self-directed, either with a self-directed service budget or an agency-provider model.
- This plan must be in writing and agreed to by the individual and must be based on a functional needs assessment. The regulations state that the person-centered service plan must reflect the services and supports that are important for the individual to meet the needs identified through an assessment of functional need.
- These plans must be reviewed, and revised upon reassessment of functional needs, at least every 12 months, when the individual's circumstances or needs change significantly, and at the request of the individual.
What advocates must do:
- Your State Medicaid Plan must be amended to include the CFC. Advocates should be at the table to ensure the services meet your needs.
- You need a statewide, multi-disability coalition and strategy to ensure your State amends its Medicaid plan to include the CFC. If your State does not already have such a coalition, the CFC presents an opportunity to develop one.
- If your State has such a coalition, convene it!
- You need to show your Governor why s/he should amend your State's Medicaid plan to provide CFC services. This will require real live people who want and need CFC services. They must be ready to speak out. CFC is a critical opportunity to end waiting lists.
- You should get to your media and explain how this program will save your State money, while bringing into your State additional Federal funds.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com.
FYI: This is the link to the actual regulation (45 pages!) It is still open for public comment and if you click on the link, there is a section that explains how to make public comment. This is about multiple populations ... elderly, other adult disabled, and IDD. This relates with the federal move to an "Administration on Community Living" department that was created.
FYI: This is the link to the actual regulation (45 pages!) It is still open for public comment and if you click on the link, there is a section that explains how to make public comment. This is about multiple populations ... elderly, other adult disabled, and IDD. This relates with the federal move to an "Administration on Community Living" department that was created.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 430, 431, 435, 436, 440,
441, and 447
[CMS–2249–P2]
RIN 0938–AO53
Medicaid Program; State Plan Home
and Community-Based Services,
5-Year Period for Waivers, Provider
Payment Reassignment, and Setting
Requirements for Community First
Choice
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
