The Patient Protection and Affordable Care Act (H.R. 3590) Passes

This is the major health care reform bill, passed by the House on March 21, 2010 by a party-line vote of 219-212 (North Carolina had the highest number of Democrats voting no - Reps. Larry Kissell, Mike McIntyre and Heath Schuler). This bill will expand health care coverage to 31 million currently uninsured Americans through a combination of cost controls, subsidies and mandates. The Democratic Policy Committee has posted a summary and more information about the bill. The Republicans have posted their own summary.

Much of this will be rolled out over time but here are some highlights most relevant to people with disabilities:
• Provide assistance for those who are uninsured because of a pre-existing condition.
• Prohibit pre-existing condition exclusions for children.
• Expand Medicaid: Beginning in 2014, all children, parents and childless adults who are not entitled to Medicare and who have family incomes up to 133% Federal poverty Level will become eligible. The federal government will pay 100% of the cost to cover the newly eligible population initially.
• The Community First Choice option was also included, although the effective date of the option was delayed until October 1, 2011. This establishes an optional Medicaid benefit through which States could offer community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require the level of care offered in a hospital, nursing facility, or intermediate care facility for the mentally retarded.
• Removes barriers to providing home and community-based services (HCBS) by giving States the option to provide more types of HCBS through a State plan amendment to individuals with higher levels of need, rather than through a waiver, and to extend full Medicaid benefits to individuals receiving HCBS under a State plan amendment.
• Extends the Money Follows the Person Rebalancing Demonstration through September 30, 2016 and changes the eligibility rules for individuals to participate in the demonstration project by requiring that individuals reside in an inpatient facility for not less than 90 consecutive days.
• Establishes a national voluntary insurance program for purchasing community living assistance services and support (CLASS program) by individuals with functional limitations.
• Expresses the Sense of the Senate that during the 111th Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need, in the community as well as in institutions.

Proposed Clinical Policy 8L Mental Health/Substance Abuse Targeted Case Management

The NC Division of Medical Assistance has posted a proposed clinical policy for an interim Mental Health/Substance Abuse (MH/SA) targeted case management service that will be delivered by Critical Access Behavioral Health Agencies (CABHA). The draft makes clear that this service definition is the INTERIM MH/SA targeted case management service that will be delivered by CABHAs. The mental health and substance abuse population groups are still included in the DMA Integrated Case Management project. An Integrated Targeted Case Management service definition will be posted in the future and will supersede this service definition. Comments may be submitted through the DMA website until April 9, 2010.

Proposed Rule on Telepractice for Speech and Language Pathology and Audiology Services

A proposed rule regarding "telepractice" for Speech and Language Pathology and Audiology Services was published in the March 1, 2010 North Carolina Register. The new rule defines telepractice as "the use of telecommunications and information technologies for the exchange of encrypted patient data, obtained through real-time interaction, from one site to another for the provision of speech and language pathology and audiology services to patients through hardwire or internet connection." Written comments or objections must be submitted by April 30, 2010, and a public hearing will be held April 23, 2010 at 1:30 pm at the Sheraton Imperial Hotel in Durham.

Implementation Update #70 was posted March 2

I am running a little behind, but just in case anyone missed it, Implementation Update #70 has been posted to the Division's web site and can be found here: http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/index.htm. There is information on:
• Suspension of Mandatory Cost Reporting For Rate Adjustments
• CABHA Update (The Centers for Medicare and Medicaid Services (CMS) have approved a State Plan Amendment (SPA) that will allow only Critical Access Behavioral Health Agencies (CABHA) to provide Intensive In-Home Services (IIH), Community Support Team (CST), and Child and Adolescent Day Treatment services effective July 1, 2010. There is also information about the continuum of care that will be expected from CABHAs and medical director exceptions.)
• Impact of Merger & Acquisitions on Enrollment/Accreditation/endorsement
• PSR Service Notes
• Child and Adolescent Day Treatment Endorsement Checksheet and Instructions
• MOA for Child & Adolescent Day Treatment
• New CAP/Targeted Case Management form for MR/DD Submissions to VO
• Policy Changes for Case Management (Limit of 3 hours per month for CAP/DA, CAP/Choice, CAP/C, CAP/MR-DD, Targeted Case Management for Persons with Developmental Disabilities, and Early Intervention. Six additional hours (24 units) may be available if needed for completing an assessment, completing a reauthorization or continued need review, or for a crisis/emergency situation. EPSDT may also necessitate additional hours. There is additional information about recipient due process.)
• Extension for Provisionally Licensed Billing
• DMA Program Integrity contract with PCG
• Payment Error Rate Measurement in NC
• Medicaid Provider Payment Suspension
• Census 2010