Policy alerts, briefs, letters & papers

This issue of the "Policy Research Brief" series summarizes the results of a national study on the status, implementation, and degree of consumer control across states. Strategies, challenges, and best practices of consumer-directed services and supports are explored. Information was gathered through interviews with administrators of developmental disabilities services in 42 states.

CMS offers guidance to states on how to avoid payments to excluded entities and the consequences of failing to prevent these payments. The letter stresses that it is the states’ responsibility to clearly communicate to providers that it is their obligation to screen employees and contractors for exclusion prior to hiring or contracting. It also provides the location of the List of Excluded Individuals/Entities which can be used to prevent improper payment.

This issue brief focuses on the special needs population of dual eligible’s as defined in the Special Needs Plan (SNP), a type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The brief concludes how the SNP has failed this population and offers recommendations for improving dual-eligible SNPs’ prospects.

The Congressional Budget Office examines the likely effects on federal spending of 115 health care reform options. Ch. 8 covers proposals on financing Medicaid and SCHIP and Ch. 10 covers long-term care options. HCBS-related options include: allowing all states to offer HCBS via Medicaid state plan amendments (#99); making HCBS a mandatory benefit (#100); and adjusting federal match rates to favor HCBS over nursing homes (#101). Also included is a presentation on the findings of the report.

The purpose of this study is to synthesize data on the impact that the Rehabilitation Act has had on the employment and post secondary education outcomes of eligible youth. It examines how well existing vocational rehabilitation (VR) structures deliver effective transition services. It also looks at the effectiveness of collaboration between VR, education, and other service systems. Finally, 11 recommendations for the U.S. Congress and various relevant federal and state agencies are given.

<i>NOTE: The effective date for this rule has been postponed to April 3, 2009 and the comment period has been reopened, pending review by the Obama administration. See "Interim Rule" below.</i> CMS issued a Final Rule giving states the flexibility to define the scope of medical assistance covered by Medicaid by offering coverage of benchmark or benchmark-equivalent benefit packages to certain recipients. The file contains the official text of the rule as entered into the Federal Registry.

The Committee compiled a brief inventory of all research and demonstration projects supported by federal agencies. Program details are not provided, but the report does describe the diverse strategies used by 27 agencies to research and support HCBS. Fields covered include biomedical sciences, housing, environmental protection, preventive care, and hospice care, among others.

Recessions deliver a one-two punch to Medicaid by undercutting available public funds and increasing demand for services. This policy brief presents several options for strengthening Medicaid during these periods. Options outlined include: directing federal funding support; quickly reauthorizing SCHIP; simplifying enrollment; easing burdens imposed by the process of proving citizenship; and expanding coverage to those hit hardest by recession.

Investing in the workforce has more benefits than improving the quality of care. The long-term care industry employs more people than nearly any other in the U.S. Direct-care jobs are the employment core of this industry and are among the nation’s fastest-growing occupations. Improving the quality of these jobs is not only vital to our social infrastructure, but has the potential to drive economic growth, particularly within low-income communities.

This report estimates that public financial and personal clinical outcomes can be improved by moving dual eligibles to capitated managed care. The authors view the clinical and eligibility characteristics of dual eligibles as well-matched to the strengths of integrated care programs. The document lays out the reasoning and data behind the estimate, recommends policy changes needed to make the transition, identifies potential barriers to implementation and offers examples from KY and MN.