On May 6, 2009, CMS proposed to rescind the following Final rules: (1) limiting Medicaid coverage of outpatient services to services payable under the Medicare program (¶180,838); (2) eliminating Medicaid payment for transportation of children with disabilities between home and school and restricting payment for services provided at school (¶180,727); and (3) narrowing the coverage of optional case management and targeted case management services (¶180,719) beyond the requirements of the Deficit Reduction Act of 2005 (PubLNo 109-171).
In response to vocal opposition by state Medicaid agencies and advocates for the poor, Congress had prohibited implementation of these rules; most recently, section 5003(c) of the American Recovery and Reinvestment Act of 2009 (PubLNo 111-5) imposed a moratorium through June 30, 2009.
CMS also proposed to delay until June 30, 2010, enforcement of the Final rule that imposed new restrictions on federal financial participation (FFP) in Medicaid expenditures of provider donations and taxes imposed by units of government. The rule, which was adopted February 22, 2008 (see ¶180,731), also has not been implemented because of moratoria enacted by Congress. The provision reducing the ceiling on indirect guarantees from 6 percent to 5.5 percent and revising the definition of "managed care provider" would not be affected because those amendments were required by the Deficit Reduction Act of 2005 (PubLNo 109-171). Comments on both rules will be accepted until June 1, 2009.
Response of state officials
Ann Kohler, director of the National Association of State Medicaid Directors (NASMD), commended CMS' actions in a letter of May 12, 2009. The rule restricting state certified public expenditures and provider taxes "oversteps the clear authority and guidelines provided by Congress," she said. She called for objective, unambiguous standards. Kohler also praised the rescission of the limitations on payments for outpatient services, case management services and administrative services by school-based personnel. The outpatient services restriction ignored the differences between Medicare and Medicaid, she said.
Proposed rules, 74 FR 21229 and 74 FR 21232, May 6, 2009.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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