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September ___, 2011
Dr. Donald Berwick
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, Maryland 21244-1850
Re: Medicaid Home Health Services
File Code CMS-2348-P
Dear Dr. Berwick:
[Organization name] submits these comments with respect to the above-referenced Notice of Proposed Rulemaking, 76 Fed. Reg. 41,032 (July 12, 2011). [information about organization]
We salute CMS's initiative in developing these regulations and (as shown by our comments below) believe that in general these new regulations will improve the lives of the Medicaid recipients who need home health services. In addition to our comments below, we support the separately-submitted comments of the National Senior Citizens Law Center.
I. Requirement of a Face-to-Face Encounter Between Beneficiary and Physician
The proposed face-to-face requirement is mandated by the Affordable Care Act, which also mandated the same requirements for Medicare’s home health benefit. For Medicare’s face-to-face requirement, the agency permitted a transitional period for implementation due to logistical challenges. We recommend that the same level of caution be applied here. We also recommend, when the home health care is complicated (for example, certain medical equipment), that CMS permit a greater period of time between the face-to-face visit and receipt of services.
II. Invalidity of “Homebound” Requirement
We support wholeheartedly the Secretary’s proposal to specify in regulations that Medicaid home health services must not be limited to recipients who are “homebound.” We note, however, that the Secretary’s proposed regulatory language does not clearly incorporate this prohibition. We recommend that the regulation specifically indicate that a homebound requirement is not permitted. We also recommend that the agency specify that Medicaid home health services cannot be contingent upon a recipient needing skilled nursing care or therapy. The agency has indicated on a number of occasions that Medicare home health requirements (and not just the homebound requirement) may not be imposed in Medicaid’s home health benefit. The home health regulations should clarify this.
III. Home Health Services Not Being Limited to Services Provided in the Home
We strongly support the Secretary’s conclusion that Medicaid home health services should not be limited to services furnished in the home. As the Secretary notes, this conclusion is consistent with the ruling of the Second Circuit Court of Appeals in Skubel v. Fuoroli, 113 F. 3d 330 (2nd Cir. 1997). The court noted in Skubel that there is a “consensus among health care professionals that community access is not only possible but desirable for disabled individuals,” and persons with disabilities often need the provision of home health services in order to leave the home and participate in community activities.
IV. Definition of Medical Supplies, Equipment and Appliances
The Secretary has proposed “criteria defining home health supplies, equipment, and appliances, to better align with the Medicare program’s definition of durable medical equipment.” We caution the Secretary in applying Medicare’s medical equipment definition to Medicaid because of the different standards that apply to the coverage of their respective home health benefits. Medicaid’s definition of “equipment and appliances” should be flexible so that beneficiaries’ needs can be met.
V. State Lists of Preapproved Items of Medicaid Equipment
We recommend that the Secretary add to Medicaid regulations the policy dictated by the Health Care Finance Administration’s letter to State Medicaid Directors on September 4, 1998, which was written in response to the decision in DeSario v. Thomas, 139 F.3d 80 (1998) (the “DeSario letter”). The DeSario letter established minimum principles that attach to a state’s use of a pre-approved list of medical equipment, but some states are failing to comply with these principles. It is therefore necessary that the Secretary incorporate the letter’s policy into regulation, so that beneficiaries are not mechanically limited to listed equipment.
Thank you for your attention to these issues, and for your initiative in developing these important regulations.
You and your staff are invited to attend a training on the EID application and eligibility process and how to conduct EID outreach. The training will be held on Wednesday, October 5, 1:00 pm – 4:30 pm at the Workforce and Technology Center, 2301 Argonne Drive, Baltimore, MD 21218 in Room T-130. The agenda is attached. Light refreshments will be served.
As many of you know, the EID Outreach Project operated by the Maryland Department of Disabilities since 2008 will cease its operations on June 30, 2012 due to the end of its federal grant. The project has assisted individuals to apply for EID and has conducted extensive outreach for the program.
The training is designed to enable other agencies to assist people to apply for EID and perform outreach to individuals they serve. Note that the training will be more detailed than the outreach presentations many of you have attended before. The session will review the intricacies of the EID eligibility process to enable agencies to help individuals navigate it successfully. The training will be delivered by the Medicaid Division of Eligibility Waiver Services (which determines EID eligibility), the Medicaid Policy Unit, and the EID Outreach Project.
Please confirm your attendance by Monday, September 19. Thank you very much!
Michael Dalto, Work Incentives Project Director
Maryland Department of Disabilities (MDOD)
217 E. Redwood St., Suite 1300
Baltimore, MD 21202
|M-7 - MD Websites Project Management Plan.doc||26 KB|
Dear Maryland Medicaid Advisory Committee Members and Interested Stakeholders:
As you may recall, the Department reviewed data that identified Medicaid’s key cost drivers at the July meeting. Our next step is to identify options to reduce costs and make the Medicaid program more sustainable. We received over 190 ideas during our public process to identify FY 2012 savings, and roughly 170 of those ideas generated savings in FY 13 or later. At the next MMAC meeting, we plan to review the 170 ideas that focus on longer-term savings. In addition, there will be an opportunity for stakeholders to provide additional ideas. We have extended the MMAC meeting for an hour to accommodate public testimony. Here are the meeting details:
Date: September 22, 2011
Location: Department of Health and Mental Hygiene, 201 W. Preston, Room L-3,
Time: 1 p.m. to 4 p.m.
Again, the goal is to make sure that we have a comprehensive list of options for reducing Medicaid program growth.
This book includes information provided at a Utilities Update Webinar presented by Cynthia J. Riely,Director, Consumer Assistance at the Office of People's Counsel on September 27, 2011.
In addition to the presentation, also included are resource sheets by jurisdiction and other fact sheets regarding contracting for electricity and natural gas services.
|Webinar 09262011 (2).pdf||139.1 KB|
|ALLEGANY CO.pdf||139.43 KB|
|ANNE ARUNDEL CO.pdf||140.6 KB|
|BALTO CITY 2011 RESOURCE GUIDE_Complete.pdf||143.62 KB|
|BALTO CO.pdf||139.67 KB|
|CALVERT CO.pdf||144.92 KB|
|CARROLL CO.pdf||142.46 KB|
|CHARLES CO.pdf||141.17 KB|
|FREDERICK COUNTY 2011 RESOURCE GUIDE.pdf||139.74 KB|
|GARRETT CO.pdf||139.01 KB|
|HARFORD CO.pdf||155.42 KB|
|HOWARD CO.pdf||141.93 KB|
|MONTGOMERY CO.pdf||145.76 KB|
|PRINCE GEORGE'S CO.pdf||146.91 KB|
|ST. MARY'S CO.pdf||142.83 KB|
|Combination of Fact Sheets 2011.pdf||119.65 KB|
|WASHINGTON CO.pdf||140.37 KB|
|Contracting for Electricity and Natural Gas.pdf||1.32 MB|
|Who We are.pdf||57.33 KB|
October 12, 2011
12-2 The Bain Center, 5470 Ruth Keeton Way Columbia, MD 21044 (410) 313.7213
October 13, 2011
5-7 The Kramer Center, 104 Powell St. Centerville, MD 21617 (410) 758.0848
October 14, 2011
10-12 North Laurel Community Center, 9411 Whiskey Bottom Rd Laurel, MD 20723 (410) 313.0390
October 21, 2011
10-12 Richard R. Clark Senior Center, 1210 E Charles St. La Plata, MD 20646 (301) 934.5423