[LGT-National] Health Reform, ask for August

[Mark_Johnson at shepherd.org]

Don't forget to wear ORANGE to Public Forums, Town Halls, etc.

Thanks,

Mark

Proposal for a Community First Choice (CFC) Medicaid State Option for
Inclusion in Health Care Reform

The core elements of the Community Choice Act (found in Section 101 of the
bill) would be structured as an option for states
to include in their Medicaid State Plans.  The Community First Choice (CFC)
Option would provide individuals with disabilities
who are eligible for nursing homes and other institutional settings with
options to receive community-based services.
CFC would support the Olmstead decision by giving people the choice to
leave facilities and institutions for their own homes
and communities with appropriate, cost effective services and supports.  It
would also help address state waiting lists for
services by providing access to a community-based benefit within Medicaid.
The option would not allow caps on the number
of individuals served, nor allow waiting lists for these services. A
significant enhanced FMAP would be provided, depending
on cost, to encourage states to select this option.

Summary of Core Provisions - This is a summary of core provisions that
should be included.  The complete language should
be drawn from S. 683/H.R. 1670.  Detailed language can be provided.

  a.. Amend Medicaid to allow state Medicaid plan coverage of
community-based attendant services and supports for certain
Medicaid-eligible individuals.
  b.. Services under this option would include services to assist
individuals with activities of daily living (ADLs), instrumental
activities of daily living (IADLs), and health-related tasks through
hands-on assistance, supervision, or cueing.  ADLs include
eating, toileting, grooming, dressing, bathing, and transferring.  IADLs
include meal planning and preparation; managing
finances; shopping for food, clothing, and other essential items;
performing essential household chores; communicating by
phone and other media; and traveling around and participating in the
community.  Health-related tasks are defined as those
tasks that can be delegated or assigned by licensed health-care
professionals under state law to be performed by an
attendant.  Services also include assistance in learning the skills
necessary for the individual to accomplish these tasks
him/herself; back-up systems; and voluntary training on selection and
management of attendants.  Certain expenditures would be excluded,
including room and board; services provided under IDEA and the
Rehabilitation Act; assistive technology
devices and services; durable medical equipment; and home modifications.
  c.. Services must be provided in a home or community setting based on a
written plan.
  d.. Services must be made available statewide and must be provided in the
most integrated setting appropriate for the
individual.
  e.. Services must be provided regardless of age, disability, or type of
services needed.
  f.. States will establish and maintain a comprehensive, continuous
quality assurance system, including development of
requirements for service delivery models; quality assurance to maximize
consumer independence and consumer
control; and external monitoring; along with other critical state and
federal responsibilities/requirements included in S.
683/H.R. 1670.
  g.. Service delivery models must include consumer directed, agency-based,
and other models, along with requirements to
comply with all federal and state labor laws.
  h.. States would be required to establish a Development and
Implementation Council to work with the state in developing and
implementing the state plan amendment necessary in order to provide the
services.  The majority of Council members must be individuals with
disabilities, elderly individuals, and representatives of such individuals,
and must collaborate with, among
others, providers and advocates.
  i.. States would receive an enhanced federal matching rate for serving
people whose costs exceed 150 percent of average
nursing home costs.
  j.. States would cooperate in reporting to Congress.
  k.. CFC services would not affect the states' ability to provide such
services under other Medicaid provisions.