Illinois Awarded Capitated Coordinated Care Model Project.
Obama Care Rules Issued.
Employment First Legislation Introduced: HB 2591
Working with the Governor’s Employment & Economic Opportunity for Persons with Disabilities Task Force, The Arc introduced House Bill 2591. The bill’s lead sponsor in the House of Representatives is Representative Ester Golar. We intend to introduce a bill in the Senate as well. This bill complements the Governor’s recent Executive Order on hiring people with disabilities.
Members of the Task Force are now preparing fact sheets on the bill that will make it the policy of this State that competitive and integrated employment shall be considered the first option when serving persons with disabilities of working age. Here is a link to HB 2591: http://www.ilga.gov/legislation/98/HB/PDF/09800HB2591lv.pdf
You can ask your Representative to become a co-sponsor of House Bill 2591.
Director Romano Letter in Chicago Sun Times
Lawsuit is stall tactic
It saddens me that people are attempting to delay the closure of the Murray Developmental Center at the expense of people with disabilities. The lawsuit mentioned in a Feb. 13 article is a stall tactic intended to further deny people with intellectual and developmental disabilities the same freedom and opportunity that we enjoy living in a community of our choice. I have enjoyed working with people with intellectual and developmental disabilities for 36 years and have witnessed those with the most severe disabilities flourish in the community. For some that means planting a garden for the first time or holding a job. For others it’s simply having a secure, predictable environment with customized supports and services that facilitate an atmosphere that promotes confidence, happiness and opportunity.
Governor’s Quinn’s Rebalancing Initiative is investing in community living and plans to shift institutional funds to community supports and services. This significant change in public policy is not only a civil liberty but also an investment in a safer, equitable and cost effective system that will maximize limited resources to serve more people. Under no circumstance will anyone with intellectual or developmental disabilities be moved into a home without trained and licensed professionals on staff. In fact, the person-centered approach makes each transition unique in that it is customized to meet individual needs including 24-hour care when necessary. Even with the closure of the Murray Developmental Center, Illinois remains one of the most institutionalized states in the nation and institutionalizes twice the number of people than any other Midwestern state. It is my belief that this lawsuit is without merit and will likely mirror the destiny of similar frivolous lawsuits in other states that failed.
Sheila Romano, Director
Illinois Council on Developmental Disabilities
Capitated Coordinated Care Model
Last Friday, HHS announced that the State of Illinois will partner with CMS to test a new model for providing more person-centered, coordinated care to Medicare-Medicaid (Duals) enrollees. Illinois is the third state with approval for a capitated demonstration to better integrate and coordinate care delivery for Medicare-Medicaid enrollees. The demonstration area includes two regions of the state in which approximately 135,000 people eligible to participate live. Subject to readiness review, enrollment would begin in October.
The Arc will continue to watch this issue. Questions on this demonstration are:
Will there be limits on the number of prescriptions per month?
Will there be therapy caps?
What will happen to coverage for services that are no longer in the State Plan but are covered by the Integrated Care Pilot?
Which Durable Medical Equipment rules will be trumped or over-ridden? Medicaid has a five year wait and Medicare does not have a waiting period.
What will the impact be on duals that are also enrolled in waivers?
Obama Care Update
Final rules issued on Essential Health Benefits and guaranteed coverage and insurance premiums.
Last Wednesday, HHS issued the final rule on the “Essential Health Benefits” that must be included in all non-grandfathered individual and small group health insurance plans, Medicaid benchmark and benchmark-equivalent plans, and Basic Health Programs in states that choose to have them. The final rule does not differ substantially from the proposed rule, in that it still allows each state to determine its own EHBs based on one of four types of benchmark plans sold in that state (see Washington Update of November 30, 2012.) For more information about the final rule, see the HHS fact sheet or press release, this article in the New York Times, or this blog post from the Georgetown Center on Children and Families.
The Department estimates that, as a result of ACA implementation through the EHB rule, 32.1 million Americans will gain access to coverage that includes mental health and/or substance use disorder benefits that comply with federal parity requirements, and an additional 30.4 million Americans who currently have some mental health and substance abuse coverage will benefit from the federal parity protections in the rule’s application of the Mental Health Parity and Addiction Equity Act, which requires that mental health and substance use disorder coverage be comparable to general medical and surgical coverage.
Insurance Market Rules. Today HHS released a final rule on Insurance Market Rules and Rate Review. The rule addresses consumer protections such as guaranteed coverage and premium rating standards. For more information on this final rule, see this HHS press release or this HHS fact sheet.
Cost sharing and preventive services. This week, HHS issued FAQs about these issues, which can be found here.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423