Harmful Medicaid Regulations Rescinded
This week, the Department of Health and Human Services (HHS) rescinded a set of harmful changes to Medicaid that would have significantly reduced funding for case management services, outpatient hospital and clinic services, and school-based administrative and transportation services. These regulations had been issued by the previous Administration but then delayed from going into effect by Congress until July 1, 2009. Download the official announcement revoking these regulations (PDF).
Some of the restrictions on the Medicaid case management benefit that will not go into effect include a reduction in the number of days of case management covered for beneficiaries transitioning from an institutional setting to community-based care, a limitation of one case manager per beneficiary, and a requirement that providers bill for case management services in 15 minute increments.
The school-based services regulations would have prohibited Medicaid payment for administrative activities performed by school personnel or contractors including outreach and enrollment and transportation costs for children to enable low-income children with special needs to access critical services.
The hospital outpatient and clinic services rule would have significantly reduced Medicaid reimbursement for community-based care including mental health care by limiting Medicaid reimbursement to only those services covered by Medicare. As a result, community-based providers would no longer have been reimbursed for day treatment and intensive psychiatric rehabilitation.
Rehabilitative Services Proposed Rule Unlikely to Resurface
The proposed rule making changes to Medicaid reimbursement for rehabilitative services is also not expected to go into effect. This proposed rule would have established a vague new standard for when other agencies or programs would be considered responsible for covering rehabilitative services instead of Medicaid. It also would have changed long-standing policy recognizing maintenance of function as a reimbursable goal of rehabilitative services in addition to restoration of function and reduction of disability. In addition, it would have eliminated reimbursement for therapeutic foster care services under Medicaid. Because these changes were included in a proposed rule that had not yet been issued in final form, HHS does not have to take action to block them from going into effect.