Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Endnotes: Citations, Additional Information, and Web Addresses

10/29/2010

  1. Gavin Kennedy, Gary Smith, and Janet O’Keeffe co-authored the original chapter. Janet O’Keeffe and Charles Moseley updated the chapter.

  2. The Court affirmed the rights of qualified individuals with disabilities to receive services in the most integrated settings appropriate to their needs. Under the Court’s decision, states are required in specific circumstances to provide community services for persons with disabilities who would otherwise be entitled to institutional services. See Introduction for more information on the Olmstead decision.

  3. The information in this section is drawn from Prouty, R.W., Alba, K., and Lakin, K.C. (Eds.). (2008). Residential Services for Persons with Developmental Disabilities: Status and Trends through 2007. Minneapolis, MN: University of Minnesota Research and Training Center on Community Living, Institute on Community Integration. Available at http://rtc.umn.edu/docs/risp2007.pdf.Additional print copies may be requested by contacting Naomi Scott at scot0387@umn.edu or 612-624-8246.

  4. HCBS waiver programs are authorized under Section (§)1915(c) of the Social Security Act.

  5. Braddock, D., Hemp, R., and Rizzolo, M.C. (2008). The State of the States in Developmental Disabilities, 2008. Boulder, CO and Washington, DC: Department of Psychiatry and Coleman Institute for Cognitive Disabilities, University of Colorado, and American Association on Intellectual and Developmental Disabilities.

  6. New Hampshire, Vermont, Rhode Island, West Virginia, Maine, New Mexico, Alaska, Hawaii, Indiana, and Oregon.

  7. Prouty, R.W., Alba, K., and Lakin, K.C. (Eds.). (2008), op. cit.

  8. Institutional services for persons with developmental disabilities are generally much more costly than nursing home services.

  9. Although the need for such intensive services may continue indefinitely for some persons, for others, the level of support required may decrease over time.

  10. Additional Federal matching funds were provided to states transitioning people from institutions to community services under the Federal MFP state demonstration grants to assist them with developing the necessary community infrastructure, among other objectives.

  11. While per capita service plans may exceed the average cost of institutional services, the aggregate costs for the waiver program must meet Medicaid cost neutrality requirements.

  12. Smith, G., Fortune, J., and Agosta, J. (2006). Gauging the Use of HCBS Supports Waivers for People with Intellectual and Developmental Disabilities: Profiles of State Supports Waivers. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. Available at http://aspe.hhs.gov/daltcp/reports/2006/gauging.htm.

  13. Prouty, R.W., Alba, K., and Lakin, K.C. (Eds.). (2008), op. cit.

  14. Version 3.5. See the Resources section of this chapter for a web link to the waiver application, instructions, and technical guidance.

  15. NFT grants were provided to state agencies--called State Program grants--and to Independent Living Centers--called Independent Living Partnership (ILP) grants. The purpose of the ILP grants was to capitalize on ILC expertise to develop outreach materials, identify and support nursing facility residents who want to transition, provide technical assistance, and supplement state transition infrastructure.

  16. These are not the grants awarded through the MFP demonstration authorized under the Deficit Reduction Act of 2005 (DRA-2005).

  17. Additional challenges are involved when downsizing or closing an institutional facility, including ensuring that any special services provided in the facility will be available to individuals after they have left the institution, maintaining the quality of facility services and worker morale, assisting workers to find other employment, and addressing the “dual funding” problem (i.e., meeting the costs of maintaining facility operations while underwriting the costs of community placement).

  18. Information in this section draws liberally fromO’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008). Enduring Changes of the FY 2001 and FY 2002 Nursing Facility Transition Grantees. Baltimore, MD: Centers for Medicare & Medicaid Services. Available at http://www.hcbs.org/moreInfo.php/doc/2353.

  19. Information in this section draws liberally fromO’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008), op. cit.

  20. See CMS Press Release, available at http://www.hcbs.org/moreInfo.php/doc/1909. See also CMS website about the MFP demonstration at http://www.cms.hhs.gov/DeficitReductionAct/20_MFP.asp#TopOfPage.

  21. Section 6071 of DRA-2005.

  22. P.L. 111-148 (signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (signed on March 30, 2010).

  23. The reports and other information concerning the MFP demonstration can be found at http://www.cms.hhs.gov/DeficitReductionAct/20_MFP.asp .

  24. Texas Health and Human Services Commission. Medicaid Reform Strategies for Texas. February 2007.

  25. Federal law mandates use of the MDS for all residents of facilities that are certified to participate in Medicare or Medicaid skilled nursing facilities and hospital-based skilled nursing units. These facilities are required to conduct comprehensive, accurate, standardized, and reproducible assessments of each resident’s functional capacity, using a Resident Assessment Instrument (RAI). The RAI consists of the MDS, Resident Assessment Protocols, and Triggers.

  26. O’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008), op. cit.

  27. Ibid.

  28. O’Keeffe, J., O’Keeffe, C., Osber, D., Siebenaler, K., and Brown, D. (2007). FY 2002 Nursing Facility Transition Grantees: Final Report. Baltimore, MD: Centers for Medicare & Medicaid Services. Available at http://www.hcbs.org/moreInfo.php/doc/2060.

  29. Information in this section draws liberally fromO’Keeffe, J., O’Keeffe, C., Osber, D., Siebenaler, K., and Brown, D. (2007), op. cit.

  30. Ibid.

  31. Case management can also be provided as an integral and inseparable part of another covered service.

  32. Medicaid funding is not available for targeted case management services provided to persons who are receiving services in an institution for mental disease, except for services provided to elderly individuals and children under the age of 21 who are receiving inpatient services.

  33. O’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008), op. cit.

  34. Ibid.

  35. O’Keeffe, J., O’Keeffe, C., Osber, D., Siebenaler, K., and Brown, D. (2007), op. cit.

  36. Ibid.

  37. Ibid.

  38. Medicaid regulations require states to maintain a program to screen nursing facility applicants and residents for serious mental illness and intellectual disability. The program’s intent is to ensure that individuals are placed in the most appropriate setting and have access to specialized mental health services where appropriate. To do this, the program uses a progressive screening process to assess whether applicants for nursing facilities have a mental illness or an intellectual disability, and if the nursing facility is an appropriate placement.

    The first test, Level I, screens for potential mental illness. All those who test “positive” must receive a more in-depth screen--Level II--that more accurately identifies mental illness and assesses whether the individual needs specialized services and nursing facility level of care. Linkins, K., Lucca, A., Housman, M., and Smith, S. (2006). PASRR Screening for Mental Illness in Nursing Facility Applicants and Residents. Report prepared for the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Available at http://download.ncadi.samhsa.gov/ken/msword/SMA05-4039.doc.

  39. O’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008), op. cit.

  40. O’Keeffe, J., O’Keeffe, C., Osber, D., Siebenaler, K., and Brown, D. (2007), op. cit.

  41. O’Keeffe, J., O’Keeffe, C., Greene, A.M., and Anderson, W. (2008), op. cit.

  42. Example taken verbatim from the Executive Summary of Summer, L. (2005). Strategies to Keep Consumers Needing Long-Term Care in the Community and Out of Nursing Facilities. Washington, DC: Kaiser Commission on Medicaid and the Uninsured. Available at http://www.hcbs.org/moreInfo.php/doc/1442.

  43. Ibid.


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