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More Information Bazelon Center's draft comments (Word file or PDF) (1/14/08) Summary of the proposed rules (HTML or easy-to-print PDF) CMS' proposed rules (Text or PDF)

Information Alert

Medicaid Case Management Rules Could Stifle Service Delivery

December 20, 2007 —The Centers for Medicare and Medicaid Services (CMS) has published interim final regulations to govern case management services under Medicaid (Federal Register, December 4, 2007, Vol. 72, No. 232, 68077-68093; 42 CFR Parts 431, 440 and 441). Under Medicaid, case management services are services that will assist individuals in gaining access to needed medical, social, educational or other services. Comments are due before 5 pm on February 4, 2008.

New Rules Implement Deficit Reduction Act

These regulations were promulgated to implement part of the Deficit Reduction Act of 2005 (DRA, Public Law, 109-171—see the Bazelon Center’s March 2006 Mental Health Policy Reporter) and are CMS’ final interpretation of Section 6052, Reforms of Case Management and Targeted Case Management. The DRA made substantial changes to many vital federal programs, including Medicaid, Medicare and TANF; with an overall focus on saving the federal government money.

Section 6052 of the DRA outlined specific provisions on what may be included in case management. It also clarified that Medicaid will not pay for certain services that have traditionally been furnished by child welfare system case managers. Additionally, it appeared to restate Medicaid’s prohibition on payment for services for which another party is liable (third-party liability) to pay for the service. However, it also stated this third-party payment exclusion applied to potential reimbursement under a “medical, social, educational or other program.” There was no further definition of what this exclusion encompasses. The March 2006 Reporter offers an analysis of the DRA and section 6052).

The Congressional Budget Office estimated that the case management changes in the DRA would save $760 million over five years. The estimate of savings resulting from this interim final regulation is far higher — $1.28 billion over five years.

See a summary of the regulations and their impact (HTML or PDF).

Public Comments Encouraged

The rules allow for a 60-day public comment period (ending at 5 p.m. on February 4, 2008). They become effective on March 3, 2008—90 days after their publication in the Federal Register. Although final on an interim basis, the rules can be modified prior to the effective date. Accordingly, advocates should submit comments to increase the likelihood of modifications (click here for how to submit comments).

You may use the Bazelon Center's draft comment letter (available as a Word file or PDF) to help shape your comments.

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