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Urgent Action AlertNew Medicaid Proposal Would Gut Community Mental Health ServicesUrge Congress to Reject the Administration=s Legislative LanguageAugust 18, 2005 C The Bush Administration has just sent Congress proposed language to amend the definitions of Medicaid rehabilitation and targeted case management services, two core elements of public community mental health systems. The changes, if enacted, could make it impossible for states and localities to bill Medicaid for intensive community-based services for adults with serious mental illness and children with serious mental or emotional disorders. Congressional committees will consider these proposals from the Centers for Medicare and Medicaid Services (CMS) in September. Members of Congress need to hear from constituents about the catastrophic impact their enactment would have on an already struggling public community mental health system. Amendment Would Cut Off Funds for Critical ServicesThe most devastating provision would limit reimbursement for both rehabilitation and targeted case management. In essence it states that if any other federal, state or local law permits these services to be furnished Cby any of various agenciesC to non-Medicaid individuals, then Medicaid cannot be billed. Beyond considering services offered through mental health systems, the ban would count mental health services funded through child welfare, education, juvenile justice, housing, job training, courts or public guardianship programs. State mental health systems now rely on Medicaid to fund well over half of the cost of community mental health services. If federal Medicaid dollars disappear, state legislatures are extremely unlikely to replace the funds This proposal would devastate community mental health service delivery through public systems. Americans with the most severe mental illnesses would be left without community care. Hundreds of community programs would likely go out of business, further reducing an already disastrously low service capacity.. To make matters worse, the Administration has again proposed to reduce federal funding for targeted case management to 50 percent (the rate for administrative services, instead of the normal Medicaid services rate for the state). Ironically, the Administration has put forth its catastrophic proposal even while endorsing the need to expand community services in a recovery-oriented mental health system (see the report of the President=s New Freedom Commission on Mental Health. New Emphasis on Achievable OutcomesCMS also proposes that both rehabilitation and targeted case management services must be Afor achievement of specific, measurable outcomes.@ This language would reduce the range of services that can be offered to those that can be demonstrated to produce good outcomes. Not all necessary mental health services can yet meet the test of being Aevidence based.@ With a requirement of Ameasurable outcomes,@ many current services would no longer be covered. For example, rehabilitation services that improve functioning would be allowed, but coverage would end for services designed to retain a person=s current functioning. Other Changes Would Restrict Access to RehabilitationOther changes to the legislative definition of rehabilitation would:
In addition, CMS has asked Congress for more explicit authority to audits states= use of the rehabilitation and targeted case management options. Children Would No Longer Be ProtectedThe mandate for children of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) would not protect them against these changes. EPSDT only requires that children have access to all services authorized under Medicaid law. These changes are proposed for the law itself. Young children who have an individualized family service plan under Part C of the Individuals with Disabilities Act (IDEA) would not be affected. Older children would suffer, however, because the changes would override language that currently authorizes Medicaid payment for services in a school-age child=s individualized education program (IEP). Take action Now!The Administration=s legislative proposals for Medicaid have been delivered to the Senate Finance Committee and the House Energy and Commerce Committee. Tell members of these committees that enactment of the proposed language would leave hundreds of thousands of adults and children without access to desperately needed care in their communities. Urge them:
Please don=t delay. Members of the key House and Senate Committees must hear quickly how drastic, unfair and dangerous these proposals are. If either of your Senators and/or your Representative are on the committees (listed below), contact their home office between now and Labor Day. You can find the address and phone numbers at http://www.congress.org If your Senators and Representative are not on these committees, please call the Capitol switchboard, 202-224-3121, to reach the committee chairs and ranking minority members. (It=s especially important to reach Senators.) Or go to congress.org, find your member=s page and use the email link or dial the number listed there. Senate Finance Committee(or go to the Committee page on congress.org) Charles Grassley (R-IA)- Chair House Energy and Commerce Committee (or go to the Committee page on congress.org) Joe Barton (R-TX-6th), Chair Fair Use PolicyPlease feel free to forward our alerts as long as you credit
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