Targeted Case Management
Update 8/15/2008
CW-TCM Coverage to Resume: On June 30, 2008, the president signed the 2008 Supplemental Appropriations Act into law, which delays the case management regulations until April 1, 2009. This delay allows MHCP to resume CW-TCM coverage for services provided after February 29, 2008, through June 30, 2008, and prospectively from July 1, 2008, through March 31, 2009.
Background: This provider update negates an earlier update announcing that MHCP would no longer cover CW-TCM services. In March 2008, to comply with an interim final rule issued by the federal Centers for Medicare & Medicaid Services (CMS), MHCP announced that child welfare targeted case management (CW-TCM) would no longer qualify for federal funding. As a result, effective for dates of service on and after March 1, 2008, MHCP would no longer cover CW-TCM services, but requested of providers and tribes to continue collecting CW-TCM data in case there was a delay in the effective date of the rule or CMS changed the regulation to retroactively allow federal funding for these activities.
Update 5/5/2008
Effort to Block Medicaid Cuts Slows in United States Senate
This
week Senate Majority Leader Harry Reid (D-Nev.) tried a
procedural maneuver to advance H.R. 5613, the bill passed by
the House last week which would block the administration’s
proposed cuts to the Medicaid program, through the Senate.
However,
Senator Tom Coburn (R-Okla.) objected, stalling the effort,
while other prominent Republicans expressed their objection
to the House approach. The bill’s powerful opponents
include Senator Chuck Grassley (R-Iowa), ranking minority
member on the Finance Committee, which has jurisdiction over
Medicaid, and Minority Leader Senator Mitch McConnell
(R-Ken.). They argue that states and counties have
taken advantage of loopholes in Medicaid and that the
administration is taking appropriate action to prevent fraud
and abuse.
Because
Senate floor time is very limited at this stage in the
legislative year, some observers believe that Reid and other
supporters will attempt to attach it to another piece of
legislation which must be passed, like the war supplemental
appropriation bill.
HHS Secretary Michael Leavitt has indicated that the administration may be willing to postpone implementation on the regulation which limits payments to county hospitals and other public providers and the one which eliminates payments for residents and interns at teaching hospitals. This compromise would let the other rules, including the rules on rehabilitation and targeted case management, go into effect. NACo is on record opposing all the Medicaid rules which cut reimbursements which would shift costs to counties and urging Congress to put a moratorium on their implementation.
Action
Needed:
Contact both your Senators
and urge them to move quickly to place a moratorium on the
seven harmful Medicaid rules which would undermine your
county’s health care safety net.
Update 4/23/2008
Congress Passes Targeted Case Management Fix
Round
1: The
House just voted Wednesday to pass HR
5613. The
vote was overwhelming and would be more than enough to
override a threatened Presidential veto. The vote was
349-62. We have confirmed that the entire Minnesota House
delegation voted in favor of the bill.
Round
2: The
Senate has not yet acted on S. 2819, which not only puts a
hold on the Medicaid rules, but would also provide
cash-strapped states with additional temporary federal
funds. The next effort will be to convince the Senate to
pass the same bill with a veto proof margin. We will
update you later, as we urge you to contact our Minnesota
Senators.
Thank you for all the phone calls and e-mails!!!!!!
Please take a moment to contact your Member of Congress and thank them for voting in favor of H.R. 5613.
Reminder: Members need to make their calls or send their emails on their breaks and from their own phones and home computers.
Update: 3/2008
County Targeted Case Management Bill Introduced:
SF 3275 (Doll) and HF 3615 (Loeffler) were introduced this week. This bill would provide for $30 million in one-time funding for targeted case management to offset federal reductions as a result of the 2006 Deficit Reduction Act, The interim final rules for that act, which took effect Monday (3/4), disallow use of Medicaid dollars for many child protection and other county services. No hearing has yet been scheduled. Counties did receive half of the necessary funds ($32 million) last year. With the budget deficit of $935 million, it will be a challenge to convince the Legislature to find new dollars to help us fill the entire hole caused by the federal decision.
Update: 2/29/2008
U.S.
Senate Approves Targeted Case Management Rule Delay: On
February 26, the U.S. Senate passed the Indian Healthcare
Improvement Act (S. 1200), which contains a provision
authored by Senator Coleman and others that protects
vulnerable Minnesotans’ access to critical health,
education and social services. Co-sponsored by Senator
Amy Klobuchar, the bipartisan legislation places a
moratorium on the Centers for Medicare and Medicaid Services’
(CMS) December 4, 200,7 rule on Case Management and Targeted
Case Management (TCM), which goes into effect on March 3 of
this year, and would redefine and place strict limits on
these services – severely limiting a state’s ability to
care for vulnerable populations. The new moratorium
would prevent these regulations from taking effect until
March of 2009, giving the government additional time to
address the rules’ unintended consequences. The
Indian Healthcare Improvement Act passed by a vote of 83 –
10.
Case
Management and TCM services are services that assist
low-income individuals and families in gaining access to
needed medical, social and educational services.
According to the Minnesota Department of Human Services, it
is estimated that the new rule could result in cuts of at
least $60.0 million for Minnesota annually, based solely on
the changes to child welfare services. It is likely
the total loss to the state could far exceed this number
when other services are also factored in.
The
bill still needs to pass the House and be signed by the
President in order to become law.
Update 2/15/2007:
Senate Blocks Cuts to State Case Management Services Under Medicaid: The Senate adopted by voice vote an amendment offered by Sens. Barbara Mikulski (D-MD), Norm Coleman (R-MN) and Amy Klobuchar (D-MN) which would delay implementation of a regulation issued by the Centers for Medicare and Medicaid Services (CMS) governing federal payments for case management services provided by state Medicaid programs. The amendment delayed the effect of the regulation until April 1, 2009 and would prevent the Administration from shifting $1.3 billion in costs of the services over five years to states. The amendment was offered to the Indian Health Care Improvement Act Amendments of 2008 (S. 1200); final passage on the bill, including the Medicaid amendment, is expected after the Presidents’ Day recess.
Rep. Pallone Introduces Bill to Increase Federal Share of Medicaid: Rep. Frank Pallone (D-NJ) introduced legislation (H.R. 5260) that would provide roughly $13 billion for a temporary increase in the federal share of Medicaid payments from April 2008 through June 2009. Reps. John Dingell (D-MI), Peter King (R-NY) and Thomas Reynolds (R-NY) were original cosponsors of the bill. For many states struggling under the faltering economy, the enactment of this bill would mean a significant increase in federal funds: for New York, an increase of nearly $1.8 billion; for California, an increase of $1.4 billion, for Pennsylvania, an increase of $633 million, for Illinois an increase of $448 million. Sen. John Rockefeller (D-WV) has introduced similar legislation (S. 2586) in the Senate. AFSCME is working for the enactment of a boost in federal Medicaid payments to states and for flexible state and local fiscal relief.
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AFSCME lobbyist Mark McAfee and Judy Schultz of Local 151 cautioned state legislators that abused children will be hurt by new federal rules that will deny Medicare reimbursement for child protection services.
“My union sisters and brothers are on the frontlines delivering human services in counties throughout Minnesota,” explained Judy Schultz, a Ramsey County social worker for 41 years. “We are the safety net for at-risk children, abused adults, the mentally ill and developmentally disabled. We help our clients gain access to the medical, social, educational and protective services that they need to become healthy, productive citizens. We save taxpayers money because our services are designed to keep clients out of more expensive care.”
“I’m here today to raise serious concerns about the new Targeted Case Management rules, which will take effect on March 3. County budgets will get crunched and jobs will be lost. But most importantly, abused children will be hurt by rules that deny Medicaid reimbursement for child protection services. Please work with AFSCME Council 5 to reverse these damaging federal rules.”
AFSCME Council 5 has formally responded to the proposed changes in Targeted Case management funding.
Many of you are aware of the drastic cuts in federal monies to the states and counties for much of the work that we do. Our Union, AFSCME, is working very hard at the federal level to address our concerns regarding those cuts. You might be interested in reading the most recent letters sent by our International staff on the issue.
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AFSCME's Response - Targeted Case Management (TCM) Funding Cuts
Thanks to our social service members and staff that helped provide information on the impact in Minnesota that we sent to the International. The comment period ended Feb. 4th and the rule is scheduled to be imposed on March 3rd. The rule will severely restrict the ability of counties to get reimbursement for case management for child protection. If the final rule is imposed broadly by the Centers for Medicare and Medicaid (CMS), it may affect other Medicaid-funded programs using case management, for the mentally ill and the disabled. The $32.7 million in state backfill money that we worked with the counties to obtain in the 2007 session has been allocated to Minnesota counties and tribes to help cover the losses anticipated in child protect for the remainder of the state biennium (ending June 30, 2009). Total losses for Minnesota for that period are estimated at $60.9 million. If the new rule hits other areas of case management, the losses will be greater. We are working with the counties and key legislators to seek additional state funds (most likely 2009 session) and with the International to support legislation to delay the new rules. ~ AFSCME Council 5 Lobbyist, Mark McAfee
AFSCME Letter - (Mikulski Amendment)
AFSCME's Response to TCM Funding Cuts (2/2008)
ANALYSIS BY CENTER ON BUDGET AND POLICY PRIORITIES(12/21/2007)
Federal Audit of Targeted Case Management Released (10/2007)
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Centers for Medicare and Medicaid Services Publishes Interim Final Rule on TCM
As many of you have probably already heard, the federal Centers for Medicare & Medicaid Services (CMS) finally published an interim final rule regarding Medicaid targeted case management (TCM) services on Tuesday, December 4th. The Deficit Reduction Act (DRA) of 2005 delegated to CMS the development of rules to define tighter restrictions on what is allowable for reimbursable targeted case management. This interim rule becomes final in 90 days or March 3, 2008, following a 60 day comment period. Comments are due to CMS by February 4th.
HSPHD targeted case management revenues will be significantly impacted if the proposed interim rule is enacted, most specifically Child Welfare Targeted Case Management (CW-TCM). Our department reduced TCM revenues by approximately $9 million in our 2007 budget in anticipation of the potential impact of such rules when they were released. We have not factored an additional decrease in revenues into our 2008 budget yet, and our very early estimate is that the rules as released will result in an annual reduction of closer to approximately $14 million.
The HSPHD Deficit Reduction Act Group has been tracking a number of issues related to the DRA and directing our department response to this act since it passed in early 2006. This group will be meeting as soon as possible to further assess the service and financial impact of this proposed rule. In addition, the group will be working on a response to the rule from Hennepin County and identifying how we can work with other counties, DHS and AFSCME to continue to seek changes to both the rule and the DRA legislation itself. County lobbyists are working currently with our two U.S. Senators to seek ways to extend the comment period to six months from the current two months established by CMS.
At the state level, DHS will be working internally to produce a summary and analysis of the interim final rule by the end of the month, develop a state response to CMS by the February 4th deadline and establish work groups, including county and tribal representatives, to address implementation issues The 2007 Legislature appropriated $32.7 million in one-time funding to temporarily mitigate federal funding losses resulting from the CMS rule when it was issued. This funding can also be used to address federal audit disallowances. The distribution of this funding is scheduled to occur after DHS has completed its analysis of the estimated fiscal impact on counties and tribes, but within 60 days of the federal publication or action (i.e., by February 4, 2008).
We will keep you updated on actions the DRA Group and HSPHD Executive Committee decide are needed due to the impact of this rule on our services and budget. There will be an impact, but we will address these impacts in as planful a manner as possible. Building better lives and stronger communities remains our focus in spite of this additional challenge. It will remain our focus as we develop implementation strategies related to this new rule.
On behalf of the HSPHD Executive Committee, my thanks for your continued dedication to the work of this department throughout the continuing challenges we are facing. Your individual contributions, regardless of where you work in this department, are critical to our overall capacity to address the needs of the clients we are called upon to serve. Thank you! As always, if any of you have questions, please feel free to call or e-mail me.
Rex A. Holzemer, Area Director, HSPHD
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Feds
release interim rules for Medicaid targeted case management
- memo from AMC
Minnesota
Counties’ Response Urged
The
Centers for Medicare and Medicaid Services (CMS) published
interim final rules on December 4 regarding targeted case
management. The rules implement changes in the federal
Medicaid statute that were made by the Deficit Reduction Act
of 2005.
Implementation
of the rules would have a highly negative impact on counties
and people on Medicaid who require child protection or have
physical or mental disabilities or chronic health
conditions. The rules limit case management services
that are necessary to assist Medicaid beneficiaries in
making successful transitions from institutional care to the
community; restrict case management services for children in
foster care; and limit state flexibility to provide and pay
for case management services in the way that would work best
for beneficiaries. (A copy of the rules is attached.)
According
to CMS, the interim final rules would save $1.28 billion
over five years. Last year, AMC estimated that the
cuts would reduce funding to Minnesota by $87 million a
year.
CMS
is soliciting comments on the proposed rules by February 4,
2008. The effective date for the rules is March 3,
2008. AMC and MACSSA will be working with counties to
formulate a statewide response from counties. We urge
individual counties to send comments. The Department
of Human Services is analyzing the rule and has indicated
that they will share that analysis with counties by late
January. AMC will provide additional information to
assist counties with rule comments. Directions on how
to respond are included in the first page of the rule.
AMC
sponsored state legislation in the 2007 session for ongoing
state funding for child protection and safety, in part to
replace the expected loss of federal funds. The 2007
Legislature appropriated $32.7 million in one-time funds to
be used upon release of the final rule. This will help
alleviate the short-term pressure on counties but is far
short of the need for stable, ongoing funding.
For more information, contact Patricia Coldwell at 651.789.4330.