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(Memphis, June 28, 2017) Mid-South ADAPT and The Memphis Center for Independent Living, along with Copper Coalition, CBTU, Indivisible Memph...

Showing posts with label ADAPT. Show all posts
Showing posts with label ADAPT. Show all posts

Thursday, May 4, 2017

ADAPT on the AHCA

ADAPT Statement in Response to Passage of the American Health Care Act in the US House of Representatives

May 4, 2017
The ADAPT Community is gravely concerned by the House of Representatives’ ill-considered passage of the American Health Care Act (AHCA). The legislation, which received significant amendments only days before the vote, has serious problems which House Republicans – in their haste to pass something and declare victory – have refused to address.
 
This legislation – if it were to pass the Senate and become law – will have a truly devastating impact on seniors and people with disabilities.  It will:
  • Destroy the insurance protections for individuals with pre-existing conditions that allow them to receive necessary healthcare services;
  • Undercut access to vital Medicaid healthcare as well as long-term services and supports (LTSS) needed by older and disabled Americans; and  
  • Eliminate the incentive to provide community-based services to disabled Americans established in the Community First Choice Option.
 
Eliminating Protections for People with Pre-existing Conditions
Although recent changes to the legislation secured the support of moderate Republicans, those changes do little, if anything, to mitigate the dangerous impact of this legislation, particularly on people with pre-existing conditions.  Insurance companies will be able to charge exorbitant premiums to disabled and elderly individuals leaving these individuals without healthcare.
 
Cutting Medicaid Funding Needed to Support Elderly and Disabled Americans
As written, the legislation will cut more than $830 billion from the Medicaid program, forcing states to choose between raising state taxes and cutting healthcare services for poor children, the disabled and seniors.  These cuts couldn’t come at a worse time.  As our population continues to age, more and more people will rely on Medicaid to cover vital long-term services and supports, further straining state resources.  States will reduce Medicaid benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to needed assistance.  Without adequate support in the community, families will be forced to place their loved ones in nursing facilities and other institutions, only increasing the strain on already-limited Medicaid resources.
 
Eliminating Federal Incentives Designed to Promote Community Integration
For elderly and disabled Americans who rely on it, Medicaid is not just a health insurance program: it literally supports their lives and their liberty.  Outside of the Disability Community, there has been virtually no public discussion about how the AHCA eliminates the enhanced Federal funding associated with the Community First Choice Option (CFCO).  CFCO was the result of nearly a quarter century of work by ADAPT and other disability rights advocates.  This Medicaid option provides additional funding to states that provide LTSS in the community to people who would otherwise be placed in a nursing facility or institution. 
 
CALL TO ACTION
We do not believe that American voters intended this Congress and President to cut vital services for economically disadvantaged, elderly and disabled Americans to provide tax breaks to the wealthiest of our nation. Indeed, President Trump campaigned on a promise that there would be no cuts to Medicaid.  Now, more than ever, it is critical that disabled and elderly individuals, their families, and their advocates understand the dangerous implications of this legislation and become politically active.  Although AHCA has passed the House, it still must pass the US Senate before it can be signed into law.  We must educate our communities about the dangerous implications of this bill and urge our Senators to vote against the bill. 
 
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ADAPT is a national grass-roots community that organizes disability rights activists to engage in nonviolent direct action, including civil disobedience, to assure the civil and human rights of people with disabilities to live in freedom.

ADAPT activists

Thursday, April 27, 2017

The Community First Choice Option


Funding Tennessee’s Community Living Services


 


ADAPT in action
The Community First Choice (CFC) Option [part of the Affordable Care Act] will revolutionize the long term services and supports (LTSS) system for Tennessee.   Federal funding is available now and the final rules are published so Tennessee should immediately move forward with the creation of the Development and Implementation Council.

 

CFC would allow Tennessee to draw down an additional federal funds that could be up to $60 million annually in Medicaid resources to sustain the shifts in the long term services and supports system.

OVERVIEW


The Community First Choice Option is a community-based Medicaid state plan service which includes hands on assistance, safety monitoring, and cueing for assistance with activities of daily living, instrumental activities of daily living and health related functions for individuals based on functional need, not diagnosis or age.

THE BASICS


The Affordable Care Act, Section 2401, added 1915(k) to the Social Security Act under Medicaid. Final rules available at 42 CFR 441 Part K or in the Federal Register at Vol. 77, No. 88 (77 FR 26828).


·       Supports choice, independence, and integration in accordance with the Olmstead decision

·       Person-centered and consumer-directed

·       Services must be provided in a home and community-based setting and CANNOT be provided in a nursing facility, institution for mental diseases (IMD), or intermediate care facility for people with development disabilities (ICF-MR)

·       Must be provided on a statewide basis

·       Eliminates HCBS waiting lists

·       States that implement CFC will receive an additional 6% in federal matching funds, with no sunset

·       States that are pursuing CFC (to date): AR, CA, CO, LA, MD, MN, NY, RI, WA

 

ELIGIBILITY


Must be Medicaid eligible

Must require an institutional level of care (hospital, nursing facility, ICF-MR, or IMD)

REQUIRED SERVICES


States must provide the following services.

 

·       Attendant services and supports to assist in accomplishing: activities of daily living (ADL), instrumental activities of daily living (IADL), and health-related tasks

·       Attendant services and supports include: hands-on assistance, safety monitoring, and cueing

·       Assistance with the learning skills necessary to accomplish ADL, IADL, and health-related tasks

·       Allows for the purchase of back-up systems (such as beepers or other electronic devices) to ensure continuity of services and supports.

·       The State must develop and offer a voluntary training to individuals on how to select, manage and dismiss attendants.

 

 

PERMISSIBLE SERVICES and SUPPORTS


States can choose to provide the following services.

 

·       Transition costs, such as security deposits for rent or utilities, purchasing basic kitchen supplies, etc.

·       Services that increase independence or substitute for human assistance, such as assistance with learning how to use public transportation, for example.

EXCLUDED SERVICES


CFC funding cannot be used to pay for the following services because either the service cannot be paid for by Medicaid or the service is available through alternative mechanisms, such as HCBS waivers.   However, similar services may be permissible under the context of “Expenditures relating to a need identified in an individual’s person-centered service plan that increases an individual’s independence or substitutes for human assistance.”

·       Room and board

·       Special education and related services provided under IDEA and vocational rehab

·       Assistive technologies (other than those used as back-up systems)

·       Medical supplies and equipment

·       Home modifications

MODELS FOR SERVICE DELIVERY


States can select one or more model for the delivery of CFC. Ideally, states will provide consumers with a robust system in order to increase choice. Services must be provided under a person-centered plan.

 

“Agency Provider Model” includes a range of approaches, with the individual having the ability to select, train, and dismiss their attendant, including:

 

Traditional agency managed services

Agency-with-Choice model where the agency operates solely as a fiscal intermediary


“Self-Directed Model with service budget” including:

·       Vouchers

·       Direct Cash Payments

·       Fiscal Agent


CONSUMER RIGHTS


Emphasis on a person directed plan and planning process, which includes individuals chosen by the consumer

Consumers can select family members (except spouse or legal guardian) or any other individuals to provide services and supports

 

·       Consumers can train workers in specific areas of care needed by the individual and to perform the needed assistance in a manner that is consistent with the individual’s personal, cultural, and religious preferences

·       Consumers can establish additional staff qualifications based on their specific needs and preferences

SO, WHAT WILL CFC LOOK LIKE IN TENNESSEE?


Many decisions still have to be made. CFC sets the framework for a fully integrated, non-diagnosis-specific, community-based service system that provides individuals the civil right to live independently in the community and out of an institution. CFC is structured to allow states to work within their unique Medicaid system of state plan services, waivers, and managed care services.


The decisions for structure, implementation, and monitoring are the responsibility of the State’s CFC Development and Implementation Council, which must be comprised of mostly people disabilities, seniors, and their representatives – as required by CFC.  

 
It is imperative that Tennessee establish its Development and Implementation Council NOW! Every day delayed is money left on the table, and people’s rights ignored.