Information Bulletin #291 from Steve Gold, August 03, 2009
Sorry for this late Information Bulletin. On June 22, 2009, CMS published an "advance notice of proposed rulemaking." Goggle 74 Federal Register 29453. Comments must be submitted by August 21, 2009 by email http://www.regulations.gov and follow instructions under more search options' tab.
Because many of these changes will be opposed by providers and special interests that have an investment in the status quo will oppose CMS proposed changes. It is therefore important for advocates and people with disabilities of all ages to make your views known.
The two CMS proposed changes are:
1. To change waivers so they can be "based on need, rather than diagnosis or condition." CMS states that the proposed change will "strengthen person-center principles."
FYI - there are currently about 350 waivers serving about 1 million people. Each waiver must serve one of three specific target populations - mentally retarded or developmentally disabled, or both; aged or disabled, or both; or mentally ill. CMS writes that the "impediment to serving more than one target group through an HCBS waiver relates to the division between the target groups..., not the associated institutional settings where those target groups would otherwise receive services but for the provision of HCBS."
The proposed change is intended to increase flexibility to combine target groups in one HCBS waiver, or to offer services based on individuals needs, instead of what target group they may fall in.
2. To address residential settings and housing, CMS recognizes that "some individuals who receive HCBS in a residential setting managed or operated by a service provider have experienced a provider-centered and institution-like living arrangement, instead of a person centered and home-like environment with freedoms that should be characteristic of any home and community-based setting."
CMS proposed that persons receiving HCBS services "must reside in the home or community," meaning either "resides in a home or apartment that is NOT owned, leased or controlled by a provider of any health-related treatment or support services; OR resides in a home or apartment that is owned, leased or controlled by a provider of one or more health-related treatment and support services, and that meets standards for community living...."
Some suggestions for comments:
1. All HCBS waivers should be based on functional needs of individuals. This will eliminate that A-MI-DA, A-MR/DD-DA, A-A/PD-DA mentally and might, just might move us to an ADA perspective.
2. All HCBS should reduce administrative waste and overlap, which combining waivers based on functional needs accomplishes.
3. Existing discrimination against people with the greatest needs, those people with the most severe disabilities, must end. In combining waivers, the proposed change must address the widespread discrimination against the most disabled members of the community.
4. Housing services are critical to transitioning back to the community. But persons in HCBS should reside in a home or apartment that is "NOT owned, leased or controlled by a provider of any health-related treatment or support services." Housing should be delinked from services - if CMS truly believes what they write about residing "where they can enjoy all the liberties of community living...[and] have maximum choice, control and individual liberties...."
5. Cost neutrality should be based on a combination of aggregate expenditures, combining the numbers of persons in a functional waiver and comparing their costs to a combination of costs of people in the relevant institutions.
Steve Gold, The Disability Odyssey continues
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To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.