JFActivist

Join ADAPT Coalition Letter to Oppose Harmful CMS Case Management Rules

ACTION ALERT!

Interim Final Rules issued by the Centers for Medicare and Medicaid Services (CMS) will reduce federal case management reimbursement targeted for transitioning people from institutional settings to the community.  Under the Interim Final Rules, CMS reduces the funding for individuals "transitioning to a community setting" from the current 180 days to only 60 days if the individual has been institutionalized for six months or more.  CMS will only allow payment for 14 days if the individual has been institutionalized for less than six months.  This change undercuts efforts at the state level to comply with the Olmstead decision, implement the Money Follows the Person Demonstration programs and support people transitioning into the community from institutional placement. 

We must let CMS know that we oppose this change. 

National ADAPT is organizing a coalition response to show the widespread opposition for this change.  If you would like to add your organization’s name to this letter, email Linda Taylor at LTaylor@rochestercdr.org and we will add you.  The deadline to respond to CMS is February 4th, so please respond to Linda before 5 pm EST on February 1st.


COALITION LETTER TO CMS OPPOSING CASE MANAGEMENT CHANGES


January 22, 2008
Dennis Smith, Director of the Center for Medicaid and State Operations
Department of Health and Human Services
Attention CMS-2237-IFC
P.O. Box 8016
Baltimore, MD 21244-8016

Re: Interim Final Rule on Case Management Services

Dear Mr. Smith:

The undersigned organizations are deeply concerned about and oppose Interim Final Rules issued by the Centers for Medicare and Medicaid Services (CMS) which will reduce federal case management reimbursement targeted for assistance transitioning individuals from an institutional setting to the community.  Under the Interim Final Rules, CMS would reduce the funding for such an individual from the current 180 days to only 60 days if the individual has been institutionalized for six months or more.  CMS would only allow payment for 14 days if the individual has been institutionalized for less than six months.

CMS staff stated that the rationale for this change, in part, is that payment for transition case management is a duplication of payment to the institution which is expected to provide “discharge planning”.  We strongly disagree with this assertion.  Transition into the community requires a great deal of work to coordinate the services and supports individuals need to be successful.   Based on the collective experience of advocates and service providers in our coalition, we know that institution-based staff is unfamiliar with the complex array of community-based housing options, services, and supports that must be navigated to transition into community living.  This work is particularly difficult and time-consuming because the entire plan must be in place at the same time.   It is impossible to effectively put one component of a plan in place and then work on another piece. 

CMS originally changed these case management rules and increased the allowable payment to address concerns that people needed additional support beyond institutional discharge planning to transition to community living.  This change was made to help states comply with the Olmstead decision.  Reversing this position simply strengthens the institutional bias and undercuts state transition efforts.  The timing on this change is particularly devastating because states are beginning to implement their Money Follows the Person Demonstration programs.  Advocates have been working with the states to use the expanded case management funding to support the work needed to make community living a viable alternative.  More importantly, this funding stream would help transition people into the community long after the demonstration program was over.

We are also concerned that the payment system creates a huge disincentive for smaller non-profit organizations to do this work.  Payment is made only after the individual has transitioned to the community.  Smaller non-profit organizations, which have been the leaders in transitioning people out of nursing facilities, often do not have sufficient cash flow to support the work while they wait months for payment.  We urge CMS to work with advocates to develop an approach which maintains accountability for the work but also addresses this concern.

Again, we urge you to retract these devastating changes.

Sincerely,

Community Choice Act Hearing - Who Showed Up, What Went Down

The House Energy & Commerce Subcommittee on Health's "Helping Families with Needed Care: Medicaid's Critical Role for Americans with Disabilities" hearing was well-attended by both Members of Congress as well as advocates, many of whom traveled from Pennsylvania, Maryland, Virginia, New York, and even Texas to attend the hearing.

Arriving at Union Station at the same time as ADAPTers from Philadelphia, we began the long trek together up to the Rayburn House Office Building in the cold just after 9:00am.

[PICTURED ABOVE, LEFT: Advocates from Philadelphia begin the trek from the train station to the hearing.]

Arriving shortly before the start of the hearing, we learned that the hearing room was already full and were directed to the overflow room on the third floor. However, easier said than done, as we next encountered broken elevators on either end of the hall. Once one set began functioning properly about ten minutes later, we made our way up to the overflow room to take in the hearing, which had already begun with opening remarks from Members.

[PICTURED RIGHT: Advocates from Philadelphia wait for word that elevators are functioning again so we can join one of the overflow rooms to watch the hearing.]

Highlights:

MEMBERS - Many of the Members, in their opening remarks, commented on their concerns regarding recent Medicaid regulations and critical services cuts on transportation and administrative reimbursements for services provided for students with disabilities. Rep. Capps (CA), a former school nurse, and Rep. Hooley (OR), a former teacher, offered particular dismay of the recent Medicaid regulations and their effect on children with disabilities staying integrated in public education.

Several members spoke of the institutional bias in Medicaid and highlighted their knowledge of the cost savings of home and community-based living over institutional placements. Members relied on examples from their own states of positive steps but outlined how each seemed to fall short of the goal presented through the Community Choice Act.

WITNESSES -

Diane Rowland of Kaiser Commission on Medicaid and the Uninsured: "Institutionalization should not be the admission ticket to home-based services under Medicaid."

Stephanie Thomas of ADAPT: "Many of ADAPT's members have done time in nursing homes and other institutions, basically becoming the cash crop for an industry that wants to draw down dollars."

Julie Beckett of Family Voices: "I'm Katie Beckett's mother and she was the first home and community-based waiver child in 1981. She sits behind me today and about to turn 30..., and we've been fighting for this for almost these full thirty years and what I would like to see is something actually done about providing home and community-based care for individuals with disabilities."

Members Who Attended:
Energy & Commerce Chairman Dingell (MI)
Subcommittee Chairman Pallone (NJ)
Subcommittee Vice-Chair Green (TX)
Subcommittee Ranking Member Deal (GA)
Rep. Murphy (PA)
Rep. Wilson (NM)
Rep. Buyer (IN)
Rep. Capps (CA)
Rep. Eschoo (CA)
Rep. Solis (CA)
Rep. Burgess (TX)
Rep. Baldwin (WI)
Rep. Schakowsky (IL)
Rep. Hooley (OR)
Rep. Towns (NY) *[thanks for mentioning this, Anita!]


Witnesses - click on the name of the witness to view their written testimony

Diane Rowland, Sc.D. Executive Director Kaiser Commission on Medicaid and the Uninsured	Julie Beckett Director of National Policy Family Voices
Stephanie Thomas National Organizer Co-Director of the Institute for Disability Access ADAPT	Celine Fortin Associate Executive Director The Arc of New Jersey
Ralph Gronefeld President and Chief Executive Officer ResCare	Aileen McCormick President and Chief Executive Officer AmeriGroup Texas, Inc.

Webcast (captioned):

- View details about downloading the archived webcast of the hearing, or connect now.
- Hearing transcript will be made available on the Subcommittee website in coming days.

Tell CMS 60 Days for Community Transitioning Isn't Enough!

This action alert comes to us from Steve Gold:

***ACTION ALERT***

Medicaid's Targeted Case Management -
Information Bulletin #232

BACKGROUND:
Forty-one States in FY 2006 received substantial
Medicaid funds (from $10 m up to $419m per year) for MA's "Targeted Case Management" services.

On July 25, 2000, the U.S. Department of Health and Human Services' Center for Medicare and Medicaid Services wrote that Targeted Case management services could be provided "to institutionalized persons who are about to leave the institution, to facilitate the process of transition to community services."

CMS wrote that these services could be used "to enable the person to gain access to needed medical, social, educational and other services in the community," including housing, rental subsidies, personal attendant care services.  CMS noted that it was encouraging States to use these services in response to the Supreme Court's Olmstead decision.

CMS told your State that Medicaid's federal reimbursement for Targeted Case Management
services "may be furnished during the last 180 consecutive days of a medicaid eligible person's
institutional stay, if [the Targeted Case Management services were] provided for the purpose of community transition."

Put simply, States received federal reimbursement for the case management work it provided to persons in nursing homes and other institutions while these persons were still in the institution and were making all the necessary preparations to move back to the community.

We know that it takes quite a bit of time to transition people from institutions to the community.  People often must obtain identification papers (a birth certificate, divers' license, baptism papers), apply for community benefits (food stamps, paratransit eligibility), make applications for affordable, accessible, integrated housing (whether public housing, vouchers, or other housing), as well as obtain appropriate durable medical equipment (many may need a motorized wheelchair which the nursing facility or other institution frequently did not provide).

CMS has issued an "Interim Final Rule" which will limit federal reimbursement for "transitioning to a community setting" to 60 days from the current 180 days. CMS has offered no explanation for the reduction and offered no examples of States' abusing the 180 days or any other reason for the reduction.

While it would be terrific if all the work could be accomplished in 60 days and the person transitioned to the community within 60 days, we all know that in many cases that is not possible. Even CMS does not respond to inquiries regarding SSDI or Medicare within 60 days!

TAKE ACTION!
Please write to the Department of Health and Human Services and let Secretary Michael O. Leavitt hear your concern.

Don't delay.  This must be done ASAP.

This CMS rule was issued on 12/4/07 and the comment period ends on 2/8/08.  You must have your comments in by 2/8/08.

1.  You can electronically submit comments to
http://www.cms.hhs.gov/eRulemaking
Click on the link "submit electronic comments on CMS regulations with an open comment period."  Use Word format. 

Remember to cite correct CMS file number.

2. Or by regular mail to:
    Department of Health and Human Services
    Attention CMS -2237 -IFC.
    P.O.Box 8016
    Baltimore, MD 21244-8016
    Re: Case Management Services' Interim Final Rule"

Please use the correct CMS file number. 

Read the entire Interim Rule.

~Steve Gold, The Disability Odyssey continues

Progress Since Olmstead - How's Your State Doing?

From Steve Gold (12/7):

Progress Since Olmstead - How Is Your State Doing? 
Information Bulletin # 231 (12/07).

In 1999, the U.S. Supreme Court held in the Olmstead decision that "unjustified isolation is properly regarded as discrimination based on disability."  The U.S. Attorney General concluded, as the Court noted, that unnecessary "retention of persons in institutions, severely limited their exposure to the outside community [and] constitutes a form of discrimination."

The Court wrote that "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life."  In the decision, the Court noted that a State's efforts should "not be controlled by the State's endeavors to keep its institutions fully populated."

Okay.  So how much progress has been made in your state between the 1999 Olmstead decision and FY 2006 (the last year for which we have data) regarding people in nursing homes?

Here is what we found using Medicaid's long-term care expenditures in both 1999 and 2006 for the nursing facility institution versus the comparable Medicaid LTC community services - those Medicaid waivers for persons eligible for nursing facilities (i.e., waivers CMS classified only for aged, aged/disabled, and physically disabled), the personal care option, and home health expenditures.

1999 - Olmstead decision - the benchmark:

Nationally 80.4% of the relevant Medicaid's long-term care institutional expenditures went to nursing facilities;

13 states spent more than 90% of their Medicaid LTC expenditures institutionally on nursing facilities (D.C, HI, IL, IN, LA, MS, NH, ND, PA, RI, SD, TN, and UT) and therefore less than 10% in the community;

Only 4 states spent less than 70% on nursing facilities (AR, NC, OR, WA);  and

The median state expenditure to nursing facilities was 84.7%.  Median means half the states spent more and half less on nursing facilities.

FY 2006 - Seven years later - how much progress has been made:

Nationally, 71.4% of Medicaid's long-term care institutional expenditures went to nursing facilities.  That's a "drop" of 9 percentage points from 1999 to 2006, i.e., national Medicaid institutional expenditures for nursing homes were reduced 9 percentage points from 80.4% in 1999 to 71.4% in 2006, and therefore nationally the states spent this additional 9 percentage in the community and

The median state expenditure to nursing facilities was 78.8% - reduction of approximately only 6 percentage points from 1999.

First, the worst states in 2006:

5 states were still spending more than 90% of their LTC on nursing facilities (IN, MS, ND, TN and UT), even though the national average was reduced to 71.4% in 2006, and

7 states had INCREASED the percentage they spent on institutional nursing facilities in 2006 from1999, i.e., they spent a larger percent of Medicaid's LTC expenditures on nursing homes in 2006 than they did in 1999 (AL, AR, DE, KY, MS, SC, and WV).

And now, the best states in 2006:

7 states spent less than 60% of their Medicaid LTC on nursing homes (the national average was 71.4%)(AK, CA, ID, NC, OR, TX and WA), therefore spent more than 40% in the community; and

9 states had a "drop" of more than 15 percentage points from 1999 to 2006 in institutional/nursing facility expenditures. (AK. AZ, CA, DC, ID, MN, NM, TX, WA) and therefor spent it in community.

So, what's up with the rest of the States:

16 states had a "drop" of less than 5 percentage points from 1999 (AL, CN, FL, GA, IN, MD, MI, MN, NH, NJ, ND, RI, TN, UT, WI and WY).

Some questions:

Why are the disability and older American advocates in the "worst states" not outraged that seven years after Olmstead their states are doing so badly?

What are their state Protection and Advocacy lawyers doing?

What are the advocates doing in the "worst states?"  Where is the next generation of lawsuits?  Other strategies?

What about the 16 states where the "improvement" was so small - less than 5 percentage points?  Aren't there disability and older American advocates in those states who are upset with the extremely slow Olmstead progress.

--Steve Gold, The Disability Odyssey continues

2006 Data for ILCs and Relocating People from Nursing Homes

From Steve Gold:

2006 Data for ILCs and Relocating People From Nursing Homes. 
Information Bulletin # 230 (12/07)

Earlier this year, we provided a breakdown by Independent Living Centers of the number of persons in 2005 that each center successfully relocated from nursing homes. We also provided national data for 2004.

Some ILCs questioned the accuracy of the data and RSA's reporting process.

Some were upset that we published the name of their ILC with the low numbers. Some thought that the ILC movement should not publicly provide the data. Please be very assured that my purpose of providing such data is to push a debate - not editorialize nor imply opinions - regarding the role of ICLs, and to move beyond whether we should be getting people out of nursing homes.

To recap, in 2004, there were 2,864 people ILCs reported to RSA, the federal funding agency, who were "successfully relocated" from a nursing facility to the community. In 2005, there were 2,867.

Pursuant to the Freedom of Information Act, we obtained RSA data for 2006.

Even though we have this information by state and by ILC, we decided to summarize the data, instead of providing it by ILC.

These results are for only federally-funded ILCs as they reported the information to RSA.

The national total for 2006 was 2,631 people whom federally-funded ILCs relocated from nursing homes.

RSA had requested each ILC to set a goal of the number of people the ILC hoped/planned/set as a goal to relocate from the nursing homes. It also requested the actual number that the ILC relocated.

These 2,631 people represent 54% of the total number (i.e., 4,894) that the 354 federally-funded ILCs had hoped to relocate and had set as their goal. Here are the results.

17% of the ILCs had set a goal of relocating zero nursing home residents.

18% had set a goal of relocating one or two nursing home residents. 18% had set a goal of three to five. 10% had set a goal of six to nine. 18% had set a goal of ten to twenty. 19% had set a goal of twenty-one or more relocations.

If these goals had been met, then the ILCs would have relocated 4,894 people from nursing homes.

The actual accomplishments show that:

21.5% of the ILCs each relocated zero nursing home residents.

23.6% of the ILCs relocated one or two nursing home residents.

15.7% relocated three to five nursing home residents.

17.5% relocated six to nine residents.

11.5% relocated ten to twenty residents.

10% relocated more than 21 nursing home residents.

The ILCs in 2006 relocated a total of 2,631 people from nursing facilities.

These percentages present a number of questions:

1. Is there a correlation between the size of the ILCs and either the goals or their actual accomplishments? A correlation between amount of ILCs budgets and accomplishments?

2. Are ILCs who relocate more people making this a budget priority regardless of size of budget? Making this a primary service and providing the "core" required service to this population?

3. What is the relationship between a State's Medicaid "targeted case management" funds and the ILCs? Do ILCs contract with the Medicaid office who receive and use these funds relocate more people than ILCs that do not?

4. Is "success" even related to the numbers? Is it fair to use data? Is it fair or reasonable to presume that ILCs should be relocating persons from nursing homes?

5. What assistance would an ILC in your State need or want in order to increase their outreach to nursing home residents? Assistance in working with their Medicaid offices? Increasing affordable, accessible housing in existing federally funded programs?

6. Is it unfair to focus on this issue without also providing data for ILCs regarding, e.g., assistance in finding employment or housing, or in diverting people from going into the institutions and staying out?

7. What would it take to increase the numbers substantially?

8. What practices are the ILCs which relocated ten or more people doing that they can share with other ILCs? What barriers have they faced? What successes did they have? What is the forum for this dialogue to take place?

9. Why isn't there a national focus on this? What has happened to the Rehabilitation Act making this a "core" service?

~Steve Gold, The Disability Odyssey continues

New Regulations Will Negatively Affect Money Follows the Person

(The following comes to AAPD from national leaders of ADAPT):

Dear Advocates for Community Integration Services:

The new Case Management regulations are here.

<<Download CMS Rules on Case Management>>

Comments are due up to 60 days after they were published in Federal Register. You can post comments online or make written comments and send them to:

Dept of HHS
Atten:  CMS-2237-IFC
P.O. Box 8016
Baltimore, MD 21244-8016

If you look at pages 24-26, there is information on transitioning folks from institutions.

Two items will NEGATIVELY affect implementation of the Money Follows the Person (MFP) Demonstration:

1.)  The regulations reduce reimbursement for Case Management from 180 days to 60 days (It was made 180 days in 2000 by CMS in response to the Olmstead  decision).

2.)  The regulations also state there will be no reimbursement to organizations until individual transitions to the community.

These two issues will harm the work of getting folks out of institutions.

WHY:
It usually takes longer than 60 days to pull together all the necessary pieces to get someone out. Getting support services, identification, financial benefits, durable medical equip and housing all add up to a very long process. The 180 days was a reasonable amount of time put in place in response to the Olmstead decision. To reverse this decision sets us back and goes against the goal in the MFP Demonstration.

Requiring that reimbursements only be made after the person gets out of the institution financially discourages small organizations who won't be able to "cash flow" the staff time necessary to get someone out.

Please read the rules and comment on other areas of concern.

- The ADAPT Community

People with Developmental Disabilities in Nursing Homes

From Steve Gold:

More on MR/DD and Nursing Facilities. 
Information Bulletin # 229 (11/07)

In July 2007, we wrote "Isn't Twenty Years Enough Time - MR/DD and Nursing Facilities?" [See Information Bulletin #219].  We pointed out that in 2007 there were about 33,000 people with a MR/DD diagnosis who resided in nursing facilities. We reviewed Congress' mandates in the 1987 Medicaid Nursing Home Reform Act, including the requirements to identify and provide specialized services for these 33,000 people.

We also broke down the 33,000 and provided by State the number of persons who have a MR/DD diagnosis, but were nevertheless in a nursing facility.

When "Twenty Years" was written, we were not aware that the Office of Inspector General, in the United States Department of Health and Human Services had recently issued a report entitled "Preadmission Screening and Resident Review for Younger Nursing Facility Residents with Mental Retardation." [#OEI-07-05-00230]

The OIG noted that Congress in 1987 had "mandated preadmission screening for individuals suspected of having ... mental retardation to ensure that: (1) nursing facilities admit only individuals needing nursing facility care, (2) these individuals' needs for specialized services are determined, and (3) these individuals obtain the services identified though the preadmission screening. The PASSRR is the primary mechanism used to meet these objectives."

The "intent of the PASRR is to ensure that individuals with mental retardation are appropriately screened, thoroughly evaluated, and placed in nursing facilities when appropriate, and that they receive all necessary services" for their Mental Retardation.

The OIG's findings are devastating.

First, even though everyone who applies to a Medicaid nursing facility is supposed to receive a "Level I PASRR screen to identify suspected mental retardation," far from everyone received a Level I screen and, of those people who did receive a screen, "one fourth were not completed ... prior to or on the date of admission."  Of those done late, on average they were completed 40 days after the resident was admitted.

So much for diverting people with MR/DD from inappropriate institutionalization!

Second, more than half the persons "suspected" of having mental retardation did not have either a Level II evaluation or Level II determination.  It's at the Level II evaluation stage that suspected MR/DD is confirmed and a determination made whether the applicant requires specialized services and requires nursing facility services.

One state had no Level II evaluations.  Of the half where a Level II was completed, many were not completed prior to or on the date of admission.

So much for States "determining whether an individual with mental retardation requires a nursing facility level of services and whether specialized services are needed."

Third, despite the OIG's recognition that the Supreme Court in Olmstead held that "the treatment, services and habilitation for a person with developmental disabilities ... should be provided in the setting that is least restrictive of the person's personal liberty'," nearly a quarter of the Level II evaluations contained no "evidence that the evaluator assessed whether the individual's total needs could be met in a community setting."

So much for the Olmstead decision providing protections for unnecessary institutionalization.

If the Level II evaluations had been done correctly, OIG noted that Medicaid's waiver program services should have been considered as appropriate placement!!!!

Since every State has a MR/DD Medicaid waiver program, which serves the mirror image of the 33,000 people with MR/DD in nursing facilities, why are these people still inappropriately in nursing facilities?

OIG stated that "If an individual's needs can be met in the community, then nursing facility services are not needed"!!!!!  While that is not rocket science and something disability advocates have been stating for the last nine years, at least, it's still great that OIG stated it.

Is there any State where disability advocates think that their folks' (with MR/DD in a nursing facility)  needs cannot be met in the community? That nursing facilities are needed for them?

Fourth, OIG stated there was at most limited oversight of preadmission screening processes at both the Federal and State levels. Only one of the States which OIG evaluated "reported specific oversight practices aimed at ensuring compliance with PASRR."

So the States are not in compliance with federal regulations for having a tracking system. But it's not just the States.  CMS, the federal funding agency, also does not conduct reviews of the States' PASRR compliance.

So obviously the States know they can get away with violating Olmstead, the Medicaid Nursing Home Reform Act, and mandatory federal regulations.  No consequences. Great scam!  Only people with disabilities get injured.

Most of the OIG's recommendations were quite lite, e.g., "CMS hold State Medicaid agencies accountable for ensuring compliance with Federal requirements."

Wow, that's a novel suggestion.

However, there was one OIG recommendation that disability advocates should use in your State.  OIG recommended that "CMS hold States accountable for considering community placements during the Level II PASRR process."  If that were really done, we would not have 33,000 people with MR/DD in nursing facilities.

Let's try to give some teeth to this last OIG recommendation. Disability advocates could file administrative complaints against both your State and CMS for violating Section 504 and the ADA, if they do not appropriately consider community placements.  You could file litigation because the people in your State in nursing facilities could and should be in the
community.

We all know that nursing facilities do not and cannot provide "habilitation" services that persons with MR/DD need.  It's really an outrage that there is anyone with a MR/DD diagnosis still in a nursing facility.  They should all be in a waiver program in the community!

--Steve Gold, The Disability Odyssey continues

Did Your State Apply for Nursing Home Diversion Modernization Grants?

From Steve Gold:

Information Bulletin #228 (11/07)

The United States Administration on Aging, Department of Health and Human Services, in September announced the 12 States which were awarded Nursing Home Diversion Modernization Grants.  These are listed below.  These 12 States received a combined federal and non-federal funded grants totally approximately $8.8 million.

The program is administered through your State Units on Aging (SUAs), in partnership with your Area Agencies on Aging (AAAs) and in collaboration with your community aging service providers and other key long-term care stakeholders.

Awards for Nursing Home Diversion Modernization Grants was competitive.

Your State had to want to divert older Americans from nursing facilities.

A state had to state how it designed to assist individuals at risk of nursing home placement and to spend down to Medicaid to receive home and community-based services that enable them to continue to live in the community. The program also encourages the Aging Services Network to modernize and transform the funding they receive under the Older Americans Act, or other non-Medicaid sources, into flexible, consumer-directed service dollars.

Whatever activities a State chooses to pursue under this grant program, by the end of the 18-month project period, the state's project must be effectively targeting flexible services to individuals who are at risk of nursing home placement and spend down to Medicaid.

The service elements were designed that the needs and preferences of consumers and their family caregivers were "fully considered in the design and implementation of the program."

Older American advocates and "other key long-term care stakeholders":

Did your State Unit on Aging apply for these competitive funds?  If not, advocates should demand a meeting, face to face, with the Director/Secretary or whatever of your State Unit on Aging and ask why they did not compete?

Does not your State want to divert people from unnecessarily going into nursing facilities?  If it says byes,' then why did it not compete for these funds.  In the previous Information Bulletin, we provided some national data. Get the data for your State before your meeting.

If it did compete and was not awarded a grant, ask to read what your State submitted.  You decide if your State proposed a diversion program you would have.

If you reside in one of the 12 States that were awarded a grant, congratulations.  If you want to know what your State has told HHS it will do, go to http://www.aoa.gov/prof/nursing/nursing_grants.asp

Awards:

    * Arkansas
    * Connecticut
    * Georgia
    * Illinois
    * Kentucky
    * Maryland
    * Michigan
    * Minnesota
    * New Hampshire
    * New Jersey
    * Vermont
    * West Virginia

    - Steve Gold, The Disability Odyssey continues

More on "One Simple Solution to Prevent Unnecessary Institutionalization"

From Steve Gold:

More on "One Simple Solution to Prevent Unnecessary Institutionalization."
Information Bulletin # 227 (11/07)

On July 18, 2007, we presented data showing that nationally nearly 12% of nursing facility residents went into nursing facilities directly from their homes, without having received any health services or attendant care supports BEFORE they were admitted into the nursing facility. There was also another 5% of nursing facility residents who also went directly from their homes but who had been receiving some health services.

These two percentages total 213,988 current residents who might still be residing in their own homes and apartments, if your State had an effective mechanism to determine what and how much health services and attendant care services were needed PRIOR to their institutionalization in nursing facilities.  With community-based services, many of these nursing facility residents might have decided to stay in their homes.

In addition, we know that nearly 56% of nursing facility residents lived with someone else prior to admission to the nursing facility.  We do not know if the persons with whom they lived were willing or able to provide assistance, nor do we know if they were even aware that community-based services might have been available. But again, did anyone from your State tell them about community-based services and ask them PRIOR to institutionalization if they wanted such services?

If, as is likely, some of the 213,988 persons overlap with the 56% of the residents who lived with another person prior to admission, it's unfortunate that effective "diversion" mechanisms did not exist to work with these people to prevent unnecessary institutionalization.

We also know that 18% of current nursing home residents have a current "support person" who wants the resident to return home.  Again, does your State ask these "support persons" what health services and attendant care services might be needed to provide appropriate and safe services in the residents' home or apartment?

Your State's can be found on the CMS website for the Minimum Data Set, http://www.cms.hhs.gov/MDSPubQIandResRep/

We return to these statistics because a number of people responded to the original "One Simple Solution"(See July 18, 2007, Information Bulletin #218) by citing their State's "preadmission" screening process.

States "screen" persons, but only to determine if they meet the requirements for nursing level of care and for Medicaid financial eligibility.

But advocates for Older Americans and persons with disabilities should ask for more.  If a State really wants to save Medicaid funds and also comply with the ADA to avoid unnecessary institutionalization, then BEFORE a person goes into a nursing facility (or ICF or Mental Institution), they (and their "support person") should be talked with as part of the eligibility screening for what services they might need to continue living in the community.

More than "screening" is necessary. People should be told exactly what services could be provided for them in the community.  They should be told the State will assist in arranging for those services immediately b not telling the person there is a waiting list for community-based services.

It's more than just screening.  It's actually offering and providing all the services a person needs to stay in the community.  Without this, screening is a sham.

Steve Gold, The Disability Odyssey continues

Community Choice Act Hearing in the Senate - Who Showed Up?

Advocates were hard at work last week contacting Members of the Senate Finance Committee, to ensure they would attend yesterday's Community Choice Act hearing, and the work paid off.

[Pictured to the left, Senator Charles Schumer (D-NY) greets advocates who rode down by bus from Rochester, NY].

The list of Senators who attended:
Gordon Smith (R-OR) 
Ron Wyden (D-OR)
Max Baucus (D-MT)
Olympia Snowe (R-ME)
John Kerry (D-MA)
Ken Salazar (D-CO)
Charles Schumer (D-NY)
Chuck Grassley (R-IA)
Blanche Lincoln (D-AR)
Jim Bunning (R-KY)

[Pictured above and to the right, dozens of advocates attended the hearing, donning orange t-shirts, which read, "Community Choice Act Now!" Our homes, not nursing homes!"]

What Was Said:

Member Statements:

Senator Max Baucus (MT)
Senator Charles Grassley (IA)

Witness Statements:

Senator Tom Harkin (IA)
Bob Liston, Director, Montana Fair Housing, Missoula, MT
Mitchell La Plante, Associate Professor, Department of Social & Behavioral Sciences, University of California, San Francisco, CA
Patrick Flood, Deputy Secretary, Vermont Agency of Human Services, Waterbury, VT
Kevin Concannon, Director, Iowa Department of Human Services, Des Moines, IA