FYI

MiCassa 2000

-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Stephanie Thomas
Sent: Tuesday, April 18, 2000 1:20 PM
To: micasa-list
Subject: addresses and 2 new micassa handouts

 Some folks ere asking about the addresses for the Senators for the
support
letters, here you go.  Also two handouts from the Harkin office that you
might find useful!


To write them:          The Honorable Tom Harkin  /     Arlen Specter
                                United States Senate
                                Washington DC 20510

                                Dear Senator ....


****************************
HANDOUT 1

        Section by Section of S. 1935:
        Medicaid Community Attendant Services and Supports Act

        Introduced by Senator Harkin (D-IA) and Senator Specter (R-PA)


        Section 1

This section includes the title of the legislation: "Medicaid Community
Attendant Services and Supports Act of 1999."

        Section 2

This section includes a statement of the Findings, Purpose, and Policy.
For
example, the research on the provision of long-term care and services
and
supports under the Medicaid program has revealed a significant bias
toward
funding these services in institutional rather than home and
community-based
settings.  Seventy-five percent of Medicaid funds for long-term services
and
supports are expended in nursing homes and intermediate care facilities
for
the mentally retarded (ICF-MRs).  Only 25% of such funds pays for
services
in home and community based settings.

Federal and State Medicaid policies should facilitate, rather than
impede,
and individual's choice in selecting where they receive long-term
services
and supports.


        Section 3

This section allows individuals who are eligible for nursing home and
ICF-MR
services under Medicaid to choose to receive community attendant
services
and supports; defines the eligible services and supports and eligible
persons; and contains funding and quality assurance provisions.


Right to Choose Community Attendant Services & Eligibility for Such
Services

The bill amends Title XIX of the Social Security Act (Medicaid
provisions)
to allow individuals who are eligible for Medicaid and who qualify for
nursing home and ICF-MR services, to choose community attendant services
and
supports in lieu of institutional care.   Individuals' eligibility is
determined without regard to age or disability.


Community Attendant Services & Supports Defined

Community attendant services and supports are defined as services that
assist in accomplishing activities of daily living (such as bathing,
dressing, toileting), instrumental activities of daily living (such as
meal
preparation, shopping, household chores), and health-related functions
(only
those that can be delegated or assigned by a licensed health
professional),
through hands-on assistance, supervision, and/or cueing.  The italicized
activities are intended to meet the needs of persons with cognitive
disabilities like traumatic brain injury, stroke and dementia, as well
as
developmental disabilities such as mental retardation and autism.

Services are further defined to include tasks such as hands-on
assistance;
the acquisition of skills so that individuals can do as many of their
own
personal tasks as possible; back-up systems such as substitute
attendants to
ensure continuity of support; and voluntary training on how to manage
attendants.

Other services are explicitly excluded from coverage, including room and
board, special education and related services, assistive technology
devices
and services, durable medical equipment, and home modifications.

Finally, there is a provision to allow for use of funds to pay for
transition costs related to moving from an institutional to community
based
setting, such as first month's rent and utilities, bedding and basic
kitchen
supplies.


Funding Provisions

If the aggregate amount of Federal expenditures on people living in the
community exceeds what would have been spent on the same people had they
been in a nursing home or ICF-MR, the State may limit the program. In
addition, States must continue to provide community-based services and
personal attendants under other Medicaid programs.


Quality assurance

States must establish a quality assurance program that includes minimum
qualifications and training for attendants, financial operating
standards
for agencies, an appeals process for eligibility denials and grievance
procedures, an external system that allows for monitoring of services by
consumers, disability organizations, family members and others,
mandatory
reporting, investigation, and resolution of allegations of neglect,
abuse or
exploitation, mechanisms to obtain consumer input through surveys, etc.,
and
a systems of sanctions, based on guidelines developed by the Secretary.


        Section 4

This section makes grants available to States to support "real choice
systems change initiatives" that include action plans to provide long
term
community services and supports to eligible individuals based on
individual
needs and consumer choice.

Grants would be awarded on a formula basis, with priority going to
states
with high levels of institutional services that have a plan to shift
resources into community-based long term care services and supports.
The
grants may be used to accomplish systems change activities, including
assessments and other data collecting activities; strategies for
modifying
policies in order to deliver more community-based services and supports,
interagency coordination, and training and technical assistance.

To be eligible to receive a grant under this section, a State must
establish
a Consumer Task Force to assist in the development, implementation, and
evaluation of real choice systems change initiatives.  The Task Force
must
include a broad range of consumers and members of the State Independent
Living Councils, Commissions on Aging, Developmental Disabilities
Councils
and other organizations providing long term care services and supports.


        Section 5

This gives States the option to waive income and resource limits to
enhance
employment opportunities for people with disabilities and to create a
Medicaid "buy-in" program.


        Section 6

This section requires the National Council on Disability to review
existing
Medicaid regulations as they relate to excessive utilization of medical
services in the provision of home and community based services, and
requires
the Secretary to submit a report to Congress on the same.


        Section 7

This section requires the Secretary to establish a Task Force on the
financing of long-term care services.

***********************************
HANDOUT 2

        Summary of S. 1935
        Medicaid Community Attendant Services and Supports Act
        Senator Tom Harkin (D-IA) and Senator Arlen Specter (R-PA)

Background

Given a real choice, most Americans who need long term services and
supports
would prefer to receive them in home and community settings rather than
in
institutions. And yet, too often decisions relating to the provision of
long
term services and supports are influenced by what is reimbursable under
Federal and state Medicaid policy rather than by what individuals need.
Research has revealed a significant bias in the Medicaid program toward
reimbursing services provided in institutions over services provided in
home
and community settings (seventy-five percent of Medicaid funds pay for
services provided in institutions).

Long term services and supports provided under the Medicaid program must
meet the evolving and changing needs and preferences of individuals. No
individual should be forced into an institution to receive reimbursement
for
services that can be effectively and efficiently delivered in the home
or
community. Individuals must be empowered to exercise real choice in
selecting long term services and supports that meet their unique needs.
Federal and state Medicaid policies should facilitate and be responsive
to
and not impede an individual's choice in selecting needed long term
services
and supports.

Summary of Legislation

The Medicaid Community Attendant Services and Supports Act of 1999 (S.
1935)
eliminates the bias in Medicaid law toward institutional care by
providing
that states offer community attendant services and supports as well as
institutional care for eligible individuals in need of long term
services
and supports. The legislation also assists states develop and enhance
comprehensive statewide systems of long term services and supports that
provide real consumer choice consistent with the principle that service
and
supports should be provided in the most integrated setting appropriate
to
meeting the unique need of the individual.

The legislation would -

--      Amend Title XIX of the Social Security Act (Medicaid provisions)
to allow
individuals who are eligible for nursing home and ICF-MR services to
choose
to receive community attendant services and supports in lieu of
institutional care.

--      Make grants available to States to support "real choice systems
change
initiatives" that include specific action steps and timetables for the
provision of community-based long term community services and supports.

--      Require the National Council on Disability to review existing
Medicaid
regulations as they relate to excessive utilization of medical services
in
the provision of home and community based services, and requires the
Secretary to report to Congress on the issue.  Also requires the
Secretary
of HHS to establish a Task Force on the financing of long-term care
services.

--      Give States the option to waive income and resource limits to
enhance
employment opportunities for people with disabilities and to create a
Medicaid "buy-in" program.




NATIONAL ADAPT MAILING LIST - Adapt MiCASA List