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Volume 13 Number 39 By Steve Teske News: Medicaid Health and Human Services Secretary Michael O. Leavitt Feb. 27 indicated he has no intention of withdrawing a controversial Medicaid rule governing targeted case management, saying the rule will prevent states from financially gaming the program. In testimony before the House Budget Committee on the Bush administration's fiscal year 2009 budget blueprint, Leavitt said states are using "fee-based contingency consultants" to get more Medicaid money via targeted case management services. The consultants are paid to increase Medicaid reimbursement, Leavitt told the committee, a practice that he said HHS is determined to stop. 'I Have to Push Back.' "We believe states are using ambiguities to unfairly increase" their share of Medicaid funding, Leavitt said in response to a question from Rep. Lloyd Doggett (D-Texas). The consultants "have no incentive but to push, push, push, push" for more funding, he added. "If I'm running a program of integrity, I have to push back." "This is good program management that we're doing," Leavitt said. Doggett accused the administration of cutting spending to states via the targeted case management rule and other Medicaid regulations, which he said would reduce spending $13 billion over five years, including $45 million over a 16-month period from the so-called TCM rule in Maine. "This administration is simply cutting the budget and letting states deal with the consequences," Doggett said. The Centers for Medicare & Medicaid Services issued the TCM rule as an interim final rule to clarify situations in which Medicaid would pay for referral services for specific, or targeted groups of Medicaid beneficiaries (No. 231 HCDR 12/3/07 a0b5m3u8b1). It specifies that the TCM definition does not cover direct medical services and other services that are integral components of another Medicaid program. The agency has said it was concerned about "inappropriate" state billing of Medicaid that had been discovered by the Government Accountability Office. The interim final rule is expected to become final the week of March 3. Senate Bill Includes Moratorium on TCM Rule A moratorium on the rule, until April 1, 2009, was included in the proposed Indian Health Care Improvement Act (S. 1200) that passed the Senate Feb. 26 by a 83-10 vote (No. 38 HCDR 2/27/08 a0b6c9z9b7). The National Governors Association also has asked CMS to withdraw the TCM rule along with several other Medicaid regulations. Officials from several state agencies held a congressional staff briefing Feb. 27 to discuss why a moratorium on the rule is needed. The briefing was sponsored by Sens. Amy Klobuchar (D-Minn.), Barbara A. Mikulski (D-Md.) and Debbie Stabenow (D-Mich.). The TCM regulation "strays far beyond congressional intent in the 2005 Deficit Reduction Act in an effort to cut $1.28 billion from this important state optional program," the lawmakers said in a Feb. 19 "Dear Colleague" letter. "The Medicaid populations most serious impacted are individuals with developmental disabilities, youth in our nation's child welfare and foster care systems, people with serious mental illnesses, low-income pregnant women, individuals living with HIV/AIDS, and children under five at risk of developmental delays," they added.
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