 October 16, 2006 Leslie V. Norwalk, Esq. Re: Administrative Changes to the Medicaid Rehabilitative Services Option Dear Ms. Norwalk: The undersigned members of the Consortium for Citizens with Disabilities (CCD) write to express our concerns with the expected regulations regarding Medicaid Rehabilitative Services and to request that the Centers for Medicare and Medicaid Services (CMS) refrain from issuing these regulations. Over the past two years, CMS has released a series of proposals, both legislative and regulatory, that, if implemented could severely restrict access to important rehabilitative services for Medicaid recipients. While CCD understands and shares CMS’ commitment to reducing Medicaid fraud and abuse, we are concerned that the agency’s proposals regarding the Medicaid Rehabilitative Services option could have a negative impact on Medicaid recipients. Medicaid rehabilitative services include intensive community services such as crisis services, medication management, skills training and other remedial services. Such services are often essential in preventing institutionalization for those with developmental disabilities, HIV/AIDS, severe mental illnesses, and disabilities due to aging. These services play a key role in ensuring the successful community integration of individuals with disabilities in the community. Therefore, improving access to rehabilitative services should be considered a critical component of the federal government’s efforts to implement the New Freedom Initiative, the Americans with Disabilities Act (ADA), and the Olmstead Supreme Court decision. Thirty-six states have indicated that they are going to apply for Money Follows the Person (MFP) demonstration funding. Under the MFP program, states will receive an increased match for one year to help people access the supports and services they need in the community and not in an institutional setting. However, after the initial year more of the financial responsibility falls on the states. CCD is extremely concerned that if states are experiencing funding cuts for rehabilitative services, they will be much less likely to be able to provide what people need in the community and there will be a return of unwarranted and inappropriate institutionalization. It is our understanding that the proposed administrative changes to Medicaid Rehabilitative Services currently under consideration would restrict coverage under this option if the services are an “intrinsic element” of any other federal, state or local program. While we recognize that the details of the implementation of this standard are largely unknown to the public, it is clear that this administrative change has the potential to severely restrict access to vital rehabilitative services as other public and private programs are unable to provide these services and/or state and local government programs cannot shoulder the significant increase in costs. This administrative change is highly controversial. As you know, this proposal was considered by Congress during the drafting of the Deficit Reduction Act of 2005 (DRA). It was soundly rejected after it became apparent that a potential negative effect could be a significant decrease in access for individuals who depend on rehabilitative services to maintain their health and independence. Reiterating those concerns expressed during the DRA negotiations, the CCD urges CMS to refrain from issuing any regulations that would reinterpret or redefine coverage for Medicaid Rehabilitative Services. CCD organizations strongly believe that such changes have the potential to restrict access to vital rehabilitative services for large numbers of individuals with disabilities. We appreciate your consideration of this important matter. Please feel free to contact Kirsten Beronio, National Mental Health Association (kberonio@nmha.org) or Kathy McGinley National Disability Rights Network (kathy.mcginley@ndrn.org) to reach CCD regarding this issue. Thank you. Sincerely, ACCESS-DSPA Alliance CC: Michael Leavitt, Secretary, Department of Health and Human Services |