|
Volume 13 Number 26 News: Medicaid Two Senate leaders Feb. 4 urged Department of Health and Human Service officials to revise an interim final rule they say would restrict the Targeted Case Management (TCM) services available to Medicaid beneficiaries. "TCM services are a critical component of the Medicaid budget offered to carefully-selected members of the most vulnerable populations in our communities. This new rule will likely adversely impact the provision of these services," Senate Majority Leader Harry Reid (D-Nev.) and Senate Finance Committee Chairman Max Baucus (D-Mont.) said in a letter to HHS Secretary Michael O. Leavitt. The Centers for Medicare & Medicaid Services on Dec. 4, 2007, issued the rule, which defines case management services and TCM services as referral services, not direct services (72 Fed. Reg. 68077). The rule is scheduled to take effect March 3. Reid and Baucus asked in their letter that it be rescinded or delayed until a new policy can be developed. Because of the referral definition, case management services exclude transportation or escort services, day care services, and other medical, social, and educational services to which eligible individuals are referred, according to the rule. The rule also specifies that TCM services exclude activities that constitute the administration of foster care programs or the administration of non-medical programs such as guardianship, child welfare or child protective services, parole and probation functions, legal services, and special education (No. 226 HCDR, 11/26/07 a0b5m3u8b1 State Medicaid directors and others have written to CMS complaining about the rule (see related item in this issue a0b5x7v0y4 DRA Scope
In their letter, Reid and Baucus argue that the interim rule goes beyond what Congress intended when it enacted Section 6052 of the Deficit Reduction Act of 2005 (DRA), which defines TCM services that are Medicaid-reimbursable. The rule will limit states' flexibility to provide and pay for the case management services beneficiaries need, the senators said.
As an example, they cited in the letter the rule's requirement that case management services be offered by a single case management provider. A single provider may not be able to address all of a beneficiary's needs or may not be best qualified to deal with certain issues, Reid and Baucus said. They added that the requirement, "in many cases, would cause an upheaval of the case management models states currently utilize."
Need for Rule
CMS said in a Nov. 30, 2007, press release that the clarifications would save the Medicaid program $1.2 billion over the next five years, citing Government Accountability Office accounts of "inappropriate" billing to Medicaid.
Citing GAO, the CMS statement said inappropriate billing resulted in $12 million in extra federal funds to Georgia and $68 million in extra federal funds to Massachusetts from 2000-2004. It added that TCM spending grew from $1.7 billion to $3 billion between 1999 and 2003, an increase GAO partially attributed to a trend in which states hire consultants to administer Medicaid.
The full text of the letter is available on the Web.
The CMS rule is available on the Web.
|
