Medicaid benes would hire and manage their own assistants under proposed rule.
If your business relies on Medicaid revenues, get ready for a possible change.
The Centers for Medicare & Medicaid Services wants Medicaid beneficiaries to be able to hire, manage and fire their own personal care assistants, rather than get aide services through a home health agency. In a proposed rule scheduled for publication in the Jan. 18 Federal Register, CMS sets out a self-directed care option for Medicaid-funded personal services.
Beneficiaries could even hire their own family members to furnish aide services, CMS notes in a press release. "This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom," Kerry Weems, CMS acting administrator, says in the release.
Under the proposal, beneficiaries would receive a cash allowance to hire workers or purchase items that would help maintain independent living. "The beneficiaries also have the option to have their cash benefit allotment managed for them," CMS allows.
States choosing to offer self-directed care would have to also make available "traditional agency-delivered services" if beneficiaries decided they wanted to discontinue self-directed care.
And states "must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants," CMS adds. "States must also train potential participants in ways to manage their budgets and assess their personal care needs."
Opponents of self-directed care argue that beneficiaries could be overwhelmed or taken advantage of under the system.
CMS will take comments on the proposed rule until Feb. 19. The 109-page notice is at
www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2229P.PDF. • Take advantage of an upcoming session to learn--and air concerns--about mandatory accreditation for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). CMS is sponsoring an audioconference on the topic on Jan. 22 from 1:00 to 2:30 p.m. ET.
Must: Participants are required to register in advance for the session, which is titled "DMEPOS Accreditation 101." To register, go to
www.2.eventsvc.com/palmettogba/012208. • The cap on outpatient therapy services under Part B will be $1,810 this year, CMS says in Jan. 19 Transmittal No. 1407 (CR 5871). The cap applies to physical and speech therapy combined and separately to occupational therapy. The cap doesn't apply to therapy services furnished under a home health plan of care.
Automatic exceptions to the therapy caps will also stay in effect this year as legislated by Congress, CMS notes in the transmittal. However, the manual exception process expired in 2007.
Part B therapy providers that want to qualify a patient for the automatic exception must use modifier KX on the therapy line item, CMS instructs. "Contractors may scrutinize claims from providers whose services exceed caps more frequently than is typical," the agency warns.
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