Federal Rules and Regulations

CMS Issues Rule on Transparency and Medicaid and CHIP Demonstration Projects

On Feb. 22, the Centers for Medicare & Medicaid Services (CMS) issued a final rule in the Federal Register, which establishes a process to promote State and federal transparency for Medicaid and Children’s Health Insurance Program (CHIP) demonstrations. The rule is designed to ensure public input in the development, review, and approval (or extension) of Medicaid and CHIP demonstration projects under Section 1115 of the Social Security Act.

Effective April 27, 2012, CMS is modifying Section 1115 demonstration information on www.Medicaid.gov and developing a demonstration application template that States can use to submit to CMS. CMS will extend a forthcoming invitation to State Medicaid and CHIP agencies to participate in an all-State call on Tuesday, February 28, 2012, from 3-4 pm ET, to provide a more detailed overview of the final rule related to Section 1115 demonstration and answer questions.

This final regulation codifies the provisions of Section 10201(i) of the Affordable Care Act of 2010, and is posted at http://www.access.gpo.gov listed under the publication date of February 22, 2012, or you can access it at http://medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html. A fact sheet on the rule is available at: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4284. For more information about approved and pending Section 1115 demonstrations, please see: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstration.html.

DOL Extends Comment Period on Companionship Regulations

Today, the Department published a notice to extend the comment period on compansionship and live-in worker regulations to March 12, 2012, because of requests received to extend the period for filing public comments and the Department’s desire to obtain as much information about its proposals as possible. Interested parties are invited to submit written comments on the proposed rule on or before March 12, 2012 at www.regulations.gov.

On December 27, 2011 the Department published a Notice of Proposed Rulemaking (NPRM) to revise the companionship and live-in worker regulations for two important purposes:

While Congress expanded protections to “domestic service” workers in 1974, these Amendments also created a limited exemption from both the minimum wage and overtime pay requirements of the Act for casual babysitters and companions for the aged and infirm, and created an exemption from the overtime pay requirement only for live-in domestic workers.

Although the regulations governing exemptions have been substantially unchanged since they were promulgated in 1975, the in-home care industry has undergone a dramatic transformation. There has been a growing demand for long-term in-home care, and as a result the in-home care services industry has grown substantially. However, the earnings of in-home care employees remain among the lowest in the service industry, impeding efforts to improve both jobs and care. Moreover, the workers that are employed by in-home care staffing agencies are not the workers that Congress envisioned when it enacted the companionship exemption (i.e., neighbors performing elder sitting), but instead are professional caregivers entitled to FLSA protections. In view of these changes, the Department believes it is appropriate to reconsider whether the scope of the regulations are now too broad and not in harmony with Congressional intent.

Reports and Resources

KFF Releases Brief on Medicaid Managed Care for People with Disabilities
Last week, the Kaiser Family Foundation (KFF) released a new issue brief related to Medicaid managed care for people with disabilities. This issue brief looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities. Drawing on existing research on Medicaid managed care and people with disabilities, the brief highlights policy considerations related to setting plan payment rates, developing adequate provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight. The brief also notes the expected growth of managed care beginning in 2014, when the ACA expands Medicaid eligibility to uninsured, low-income adults, including people with disabilities. To read the brief, go to: http://www.kff.org/medicaid/upload/8278.pdf.

AAHD Publishes Weekly Alert on Disability and Public Health

The American Association on Health and Disability (AAHD) publishes an overview

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of the prior week’s media coverage on topics related to disability and public health each Tuesday. The goal is to keep colleagues and friends informed of disability and public health topics in the media at the local, State and national level. To view recent publications go to: http://www.aahd.us/page.php?pname=media/archives/media/2012volii.8&PHPSESSID=5a0e593dde6943afcc914b26702f3fd0.

AHRQ Releases Report on Care Coordination Accountability Measures

As a result of the 2011 the Agency for Healthcare Research and Quality (AHRQ) report, the Care Coordination Measures Atlas, a compendium of existing measures of care coordination, AHRQ funded the report, Care Coordination Accountability Measures for Primary Care Practice. This report presents measures selected systematically from the Atlas that are well suited for use by health plans and insurers to assess the quality of coordination in primary care practices and by primary care practices themselves to assess their own performance. Care coordination has been recognized as an important aspect of high quality, patient-centered care. Measures of care coordination processes can be used to generate evidence about care coordination and its outcomes; evaluate current practices; design, implement, and assess improvement activities; and support payment initiatives that target care coordination. To view the report go to: http://www.ahrq.gov/qual/pcpaccountability/pcpaccountability.pdf.


HHS Takes Action to Ensure Equal Access for the Deaf and Hard of Hearing

Last Week, HHS’ Office for Civil Rights (OCR) entered into a settlement agreement with Advanced Dialysis Centers in Randallstown Maryland (“ADC”), to ensure individuals who are deaf and hard of hearing have equal access to programs and activities as required under Section 504 of the Rehabilitation Act (Section 504) and the Americans with

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Disabilities Act (ADA). This settlement follows an OCR investigation into a complaint filed by the sister of a deaf patient at ADC who alleged that the facility repeatedly failed to provide adequate sign language interpreter services essential to her brother’s understanding of important medical decisions and treatment options.

OCR found that ADC engaged in unlawful discrimination on the basis of disability by repeatedly failing to provide the patient who was deaf, a sign language interpreter while he was receiving treatment at the facility. In addition, OCR also found that ADC did not have any policies or procedures in place to address how to communicate with patients who are deaf or hard of hearing, and had not developed resources or auxiliary aids to assist in effectively communicating with these patients.

ADC has agreed to take several steps to come into compliance with Section 504 and ADA, including ensuring patients are provided interpreters in a timely manner and drafting policies and procedures which ensure effective communication with deaf or hard of hearing patients and/or companions. ADC has also agreed to train all staff on their non-discrimination obligations and provide patients notice of their right to appropriate auxiliary aids and services free of charge and the process for filing and resolving grievances about such services. The HHS Settlement Agreement can be found on the OCR website at:www.hhs.gov/ocr/civilrights/activities/agreements.

People who believe that an entity receiving federal financial assistance has discriminated against them (or someone else) on the basis of disability, may file a complaint with OCR at: http://www.hhs.gov/ocr/civilrights/complaints/index.html.

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