August 08, 2009
Saturday

(SitNews) - The Alaska Division of Senior and Disabilities Services will start processing applications for Personal Care Assistant (PCA) services at 8 a.m. next Wednesday, Aug. 12. The federal Centers for Medicare and Medicaid Services (CMS) had the state stop taking new applications on June 26, giving the state a window to process late reassessments and improve administrative procedures for PCA services and the state's four Medicaid waiver programs.

According to the division's website, the temporary moratorium remains in place for the state's four Medicaid waiver programs. However, The federal Centers for Medicare and Medicaid Services (CMS) clarified that individuals who had their waiver applications completed and accepted as of June 26 are actively enrolled in the program and are not affected by the moratorium. These are individuals who had been found to meet financial and care-need thresholds prior to June 26th.

The Centers for Medicare and Medicaid Services (CMS) is responsible for federal oversight of waiver and State plan programs including assuring that states maintain administrative authority over these programs and provide sufficient operational and programmatic oversight. Based on the review of information provided by June 26, insufficient evidence existed to assure CMS that Alaska is operating the HCBS waivers and providing State plan PCS in ways which ensure the safety of the waiver and other program participants.

In a summary, based on the Centers for Medicare and Medicaid Services(CMS) review of information provided by the State and other stake holders, CMS reported concerns on June 26th in the following general areas:

1) Federal regulations at 42 CFR 44 1.302(aj specify that the Medicaid agency must satisfactorily provide Centers for Medicare and Medicaid Services (CMS) with the assurance that "necessary safeguards have been taken to protect the health and welfare of the recipients of the services." The Alaska State Medicaid Agency has not provided Centers for Medicare and Medicaid Services (CMS) sufficient assurance that those necessary safeguards are currently in place and or being followed.

2) The State is providing Personal Care Assistant (PCA) services in a way that is not compliant with its currently approved State plan. The culmination of these issues has significant potential to negatively impact the health and welfare of many Alaska residents who are eligible for Medicaid.

Since June 26th, the state and the Centers for Medicare and Medicaid Services (CMS) have collaborated on a thorough review of how Alaska runs PCA services. As a result CMS has determined that the temporary moratorium would no longer be applied to these services.

"We're very glad to have reached this understanding, and we will actively work to connect these Alaskans with services as soon as possible," said Bill Hogan, Commissioner of the Department of Health and Social Services.

"I congratulate the Department of Health and Social Services on its work with the Centers for Medicare and Medicaid Services, and thank our federal partners for their assistance to reinstate PCA services as quickly as possible," Governor Sean Parnell said. "This significant development is a reflection of the diligence of department employees, who are committed to accepting constructive feedback and constantly improving services for Alaskans. I trust we will soon see the moratorium on Medicaid waiver program applications lifted as well."

The state is also examining ways to streamline PCA access to services. In the coming months, the division will propose a series of changes to make the PCA enrollment process faster and services more flexible.

"We are delighted with this progress, and look forward to a lifting of the moratorium in our Medicaid waiver programs for those individuals in emergency and high risk situations in the very near future," said Division Director Rebecca Hilgendorf. "We appreciate the expertise and national perspective CMS brings to our joint effort to improve Alaska's waiver and Personal Care Assistance service system."

An overall corrective action plan is due to Centers for Medicare and Medicaid Services (CMS) by Sept. 3.

Highlights of the required corrective action noted on June 26th include the following:

The Centers for Medicare and Medicaid Services (CMS) imposed a moratorium on new admissions or enrollments into Alaska's four HUBS waiver programs: The State must direct all staff and managers responsible for operation of the IICBS and PCA programs to attend basic HCBS training, as well as to actively engage in CMS-mandated technical assistance to be provided by NQE; and The State must either revise its PCA program or amend its Medicaid State plan lo assure compliance with federal rules in the delivery of PCS. in order to continue claiming these costs on the CMS-64.

In addition, CMS recommends that:

1) The State not submit any new HUBS waiver application(s) until the State can demonstrate that it is compliant with federal rules regarding the administration of its existing waivers; and 2 ) The State consider including mortality review in its critical incident reporting system.

Providers and Medicaid recipients with questions can contact Angela Salerno at 1 (907) 465- 4874, or angela.salerno@alaska.gov.

On the Web:

The federal Centers for Medicare and Medicaid Services (CMS) Review
http://hss.state.ak.us/dsds/cmsreview

Download the CMS Preliminary Review & Findings - 6/26/09
http://hss.state.ak.us/dsds/cmsreview/AK_HCBS_Review_Preliminary_Letter_06-26-09.pdf

Source of News:

The Centers for Medicare and Medicaid Services (CMS) letter dated June 26, 2009
http://hss.state.ak.us/dsds/cmsreview/AK_HCBS_Review_Preliminary_Letter_06-26-09.pdf

Alaska Department of Health & Social Services
www.hss.state.ak.us

 

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