For Immediate Release: Wed., Oct 13, 2004
Contacts: Chris Burley, Bazelon Center
for Mental Health Law, 202-467-5730 x 133 OR Brendan
McTaggart, National Health Law Program, (202) 289-7661
Healthcare Advocates Criticize DC Medicaid Proposal
Groups Say Rule Change Would Threaten Access to Services
Washington, DC (Oct. 13, 2004)—A diverse coalition of more
than 30 local and national healthcare advocates today blasted a
proposed change to the District’s Medicaid plan, charging that
the proposal would violate DC and federal laws and regulations and
potentially
undermine access to needed services in the community.
“This proposal sets the stage for dramatic cuts in services
for DC Medicaid recipients,” said Steve Hitov, managing attorney
at the National Health Law Program. “If these regulations are
enacted, the District could maintain the appearance of coverage for
needed services without actually providing them.”
The proposal, which was advanced in secret until published Sept.
3 in the District of Columbia Register, would amend DC’s Medicaid
regulations by repealing sections related to “Skilled Nursing
Facility Criteria” and adding a chapter entitled “Medically
Necessary Services.”
“Medical necessity unlocks the door to Medicaid coverage for
needed services,” said Christine Vaughn, staff attorney and
Skadden fellow who represents DC children at the Bazelon Center for
Mental Health Law. “Now it looks as if the District wants to
change the locks by categorizing many critical services as unnecessary.”
In a letter sent to District officials earlier today, the Bazelon
Center and other advocates expressed several concerns about the proposed
regulations:
-
Medicaid recipients could be denied preventive, palliative
and maintenance health care services. The proposed
regulations limit “medically
necessary services” to those required to “prevent, identify
or treat” a patient’s “illness, injury or disability.” Essential
services could be excluded under this definition, including prenatal
care and other reproductive health services and care aimed at easing
the suffering of the terminally ill. The definition could also limit
coverage of care that maintains a person’s functional abilities,
but does not clearly “prevent, identify or treat” the
illness or disability itself—a change that could have
a profound effect on access to rehabilitative physical and
mental
health services.
-
People with disabilities could be denied access to long-term
care services. By requiring that certain services
be provided only in what is considered a “skilled nursing facility,” the
proposal could force Medicaid recipients with disabilities
to decide whether to go into nursing homes or forego services
altogether.
Advocates
also believe that the proposed regulations disregard at least
10 separate existing District regulations, the D.C. Medicaid
state plan,
and approved federal waivers that set forth appropriate functional
criteria for determining access to Medicaid long-term services
by people with disabilities.
-
Patients with cancer may not have access to the latest
in needed health interventions. The proposal limits
all access to “experimental” treatments.
In many cases, treatments that are generally accepted by the professional
medical community as effective and proven interventions may be considered
experimental. Under the proposal, a person with cancer could be denied
necessary treatment because the treatment needed is new or rarely
used. Medicaid beneficiaries with rare diseases, or who use medication
under the supervision of their doctor for an “off-label” use,
could also be denied potentially life-saving interventions.
-
Children in residential treatment centers (“RTCs”)
could be returned to the District without a plan to keep them
safe. The proposal could be used to put children with the serious
mental
health needs on the street, without any connection to needed
mental health care.
"If the definition of medical necessity needs rethinking, the
process should be done with the input of the community who understand
the needs of District residents," said Vaughn.
A final decision on the rule is expected by November 3.
# # #
The Bazelon Center for Mental Health Law is
a national legal advocate for people with mental disabilities. For more information, see www.bazelon.org.
The National Health Law Program is a national
public interest law firm working for justice in health care for
America's
working and unemployed poor, minorities, the elderly and people with
disabilities. For more information, see www.healthlaw.org.
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