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Protect Medicaid Reimbursement for Case Management

Ask your Senators and Representative to
Cosponsor Legislation Delaying Medicaid Regulations

Background

Last month, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (CMS-2237-IFC). This regulation will drastically cut Medicaid funding for case management services that currently assist Medicaid-eligible children and adults with disabilities to access essential long term supports, social, medical, educational and other services.

We are opposed to a number of the provisions of this rule, particularly the following new restrictions:

• Transition case management services, which are critical to assisting individuals in moving from institutions to the community, are limited to a maximum of 60 days. Current CMS policy allows for up to180 days, which is often necessary to find housing and necessary supports for an individual to live in the community.
• Providers can only be paid for transitional case management services once an individual has successfully transitioned into the community. Unfortunately, due to circumstances well beyond the control of service providers (e.g., the availability of appropriate support services), transition can occur long after the necessary case management services have been provided. Many service providers do not have the financial capacity to wait for reimbursement or to sustain the financial losses if an individual's transition is not successful.