|
The Honorable
[Name of Senator or Representative]
[1234 Senate
Office Building]
Washington, DC
12345
Dear Senator [Smith]:
I am writing on behalf of the Elm City Center and
Morgan/Scott Mental Health to urge you to oppose legislation that would have
an unprecedented, disastrous impact on the U.S. public mental health system.
Rehabilitation and case management services are core elements of the
nation’s efforts to help the more than 25 million Americans with serious
mental illnesses live successfully in the community. These programs are
threatened by a recent administration legislative proposal to severely
restrict Medicaid funding for these services.
On August 5th, the Secretary of the
Department of Health and Human Services, Michael O. Leavitt sent
congressional leaders proposed legislation that would achieve substantial
cuts in the Medicaid program. This proposed legislation is intended to guide
Congress as it crafts legislation to achieve $10 billion in Medicaid cuts as
part of the budget reconciliation process that must be completed this fall.
An important part of the administration’s approach to
achieving Medicaid savings includes tightening service definitions for case
management and rehabilitation programs. The intent is to discontinue the
practice of billing state administrative activities as “services” for
federal reimbursement, an inappropriate cost-shifting technique that has
been employed by state Medicaid agencies. But the effect of the
proposal’s provisions extends far beyond this purpose, effectively
eliminating all funding for case management and rehabilitation under
Medicaid.
For example, the proposed legislation would end
Medicaid funding for services that seem to be duplicated by other state or
county agencies. If a county office of mental health provided referrals to
community health clinics, and a case management service also provided these
referrals, the case management program would not be able to bill these
referrals to Medicaid. Providing referrals is central to the functioning of
case management programs, many of which have been established as
evidence-based practices in achieving improved health outcomes through their
intensive and comprehensive approach to assisting people with disabilities.
Since the express purpose of case management services under Section
1915(g)(2) of the Social Security Act is to “assist individuals eligible
under the plan in gaining access to needed medical, social, educational, and
other services,” it is clear that this requirement to avoid duplicating
services would decimate these programs.
In addition, the proposal contains provisions that
would impose extreme and unreasonable requirements on the provision of case
management and rehabilitation services. One such provision requires that
people with disabilities be dropped from rehabilitation programs once they
reach a plateau and cannot reach higher levels of functioning, regardless of
any need for services that help in maintaining their current level of
functioning. Another provision requires intensive evaluation of
rehabilitation outcomes for each person served, a requirement that states
will find difficult to meet since limited funds exist to provide for such an
expansion of service activities.
No aspect of the administration’s proposal affecting
Medicaid case management or rehabilitation services should be included in
budget reconciliation legislation. The Centers for Medicare and Medicaid
Services (CMS) can achieve its aims in creating a firewall between services
and state administrative functions by promulgating regulations under its
existing statutory authority and effectively enforcing existing regulation.
We greatly appreciate your consideration of this
issue, which is of such vital importance for people with severe mental
illnesses.
Sincerely,
Your Name
Address |
Illinois
