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B-224915, MAR 30, 1987

B-224915 Mar 30, 1987
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A STATE PLAN AMENDMENT FOR CASE MANAGEMENT SERVICES IS EFFECTIVE NO EARLIER THAN THE FIRST DAY OF THE CALENDAR QUARTER IN WHICH IT WAS SUBMITTED. WAS INTENDED TO ALLOW STATES TO AMEND THEIR STATE PLANS TO COVER CASE MANAGEMENT SERVICES WITHOUT REQUIRING THAT THE SERVICES BE AVAILABLE THROUGHOUT A STATE AND WITHOUT REQUIRING THAT COVERED SERVICE BE EQUAL IN AMOUNT. SHE ALSO ASKS WHETHER THIS PROVISION WAS INTENDED TO ALLOW STATES THE OPTION OF ADDING CASE MANAGEMENT SERVICES TO THEIR STATE PLANS. THE GENERAL SCOPE OF SECTION 9508 IS ALSO DISCUSSED. WHAT IS THE EFFECTIVE DATE OF SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985? SINCE THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985 WAS ENACTED ON APRIL 7.

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B-224915, MAR 30, 1987

DIGEST: 1. UNDER SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985 (COBRA), PUB.L. NO. 99-272, 100 STAT. 210-211 (1986), A STATE PLAN AMENDMENT FOR CASE MANAGEMENT SERVICES IS EFFECTIVE NO EARLIER THAN THE FIRST DAY OF THE CALENDAR QUARTER IN WHICH IT WAS SUBMITTED, BUT NO EARLIER THAN APRIL 7, 1986, THE DATE OF COBRA'S ENACTMENT. 2. SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985 (COBRA), PUB.L. NO. 99-272, 100 STAT. 210-211 (1986), WAS INTENDED TO ALLOW STATES TO AMEND THEIR STATE PLANS TO COVER CASE MANAGEMENT SERVICES WITHOUT REQUIRING THAT THE SERVICES BE AVAILABLE THROUGHOUT A STATE AND WITHOUT REQUIRING THAT COVERED SERVICE BE EQUAL IN AMOUNT, DURATION AND SCOPE FOR CERTAIN MEDICAID BENEFICIARIES.

THE HONORABLE GUY VANDER JAGT:

THIS RESPONDS TO YOUR SEPTEMBER 29, 1986, LETTER TRANSMITTING A LETTER FOR OUR COMMENT FROM MS. L. ANNETTE ABRAMS, DEPUTY DIRECTOR, BUREAU OF INTERGOVERNMENTAL RELATIONS AND HUMAN RESOURCES, OF THE MICHIGAN DEPARTMENT OF MENTAL HEALTH. MS. ABRAMS' LETTER REQUESTED CLARIFICATION OF SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT (COBRA) AS IT PERTAINS TO STATES SEEKING MEDICAID REIMBURSEMENT FOR CASE MANAGEMENT SERVICES. SPECIFICALLY, MS. ABRAMS WANTED TO KNOW THE EFFECTIVE DATE OF SECTION 9508, PARTICULARLY WITH RESPECT TO THE STATE'S PLAN TO AMEND ITS MEDICAID PLAN TO PROVIDE THESE SERVICES EFFECTIVE OCTOBER 1, 1986. SHE ALSO ASKS WHETHER THIS PROVISION WAS INTENDED TO ALLOW STATES THE OPTION OF ADDING CASE MANAGEMENT SERVICES TO THEIR STATE PLANS.

WE REQUESTED AND RECEIVED THE VIEWS OF THE HEALTH CARE FINANCING ADMINISTRATION (HCFA) ON THESE ISSUES. AS EXPLAINED BELOW, IT APPEARS THAT THE MICHIGAN MEDICAID PLAN MAY BE AMENDED TO PROVIDE CASE MANAGEMENT SERVICES COVERAGE AT THE BEGINNING OF ANY QUARTER, IF MICHIGAN HAS SUBMITTED AN AMENDMENT TO THE STATE PLAN COVERING THIS SERVICE DURING THAT QUARTER, BUT IN NO CASE EARLIER THAN APRIL 7, 1986. THE GENERAL SCOPE OF SECTION 9508 IS ALSO DISCUSSED.

WHAT IS THE EFFECTIVE DATE OF SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985?

SECTION 9508 PROVIDES THAT "THE AMENDMENTS MADE BY THIS SECTION SHALL APPLY TO SERVICES FURNISHED ON OR AFTER THE DATE OF THE ENACTMENT OF THIS ACT." PUB.L. NO. 99-272, 100 STAT. 210-11 (1986). SINCE THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985 WAS ENACTED ON APRIL 7, 1986, MS. ABRAMS BELIEVED THAT STATES SHOULD BE ALLOWED TO BE REIMBURSED FOR CASE MANAGEMENT SERVICES AS OF THAT DATE. HOWEVER, IT WAS MS. ABRAMS' UNDERSTANDING THAT HCFA WAS NOT GOING TO APPROVE CASE MANAGEMENT PROPOSALS UNTIL AFTER IMPLEMENTING REGULATIONS HAD BEEN ISSUED.

ACCORDING TO HCFA, IT IS NOT DELAYING IMPLEMENTATION OF SECTION 9508 UNTIL FINAL REGULATIONS ARE ISSUED. HCFA INDICATES THAT A NUMBER OF STATE PLAN AMENDMENTS FOR CASE MANAGEMENT SERVICES ARE CURRENTLY UNDER REVIEW AND SOME HAVE BEEN APPROVED. HCFA ALSO EXPLAINS THAT A STATE PLAN AMENDMENT IS EFFECTIVE NO EARLIER THAN THE FIRST DAY OF THE CALENDAR QUARTER IN WHICH IT WAS SUBMITTED, AND FOR CASE MANAGEMENT SERVICES, NO EARLIER THAN APRIL 7, 1986. SEE 45 C.F.R. 201.3(G) (1985).

WE FIND HCFA'S INTERPRETATION TO BE REASONABLE. MEDICAID SERVICES ARE REIMBURSABLE ONLY IF THE SERVICES IN QUESTION ARE PART OF A STATE'S APPROVED PLAN. THUS, EVEN THOUGH THE AMENDMENT APPLIES TO SERVICES FURNISHED ON OR AFTER THE DATE OF ENACTMENT, REIMBURSEMENT IS ONLY ALLOWED IF THE PLAN PROVIDES FOR SUCH SERVICES.

WHAT IS THE SCOPE OF SECTION 9508 OF THE CONSOLIDATED OMNIBUS RECONCILIATION ACT OF 1985?

MR. ABRAMS REQUESTS CLARIFICATION OF THE EFFECT SECTION 9508 OF COBRA HAD ON THE PROVISION OF CASE MANAGEMENT SERVICES UNDER MEDICAID. SHE QUESTIONS THE EFFECT OF THIS AMENDMENT AND IS CONCERNED THAT, IF SECTION 9508 REFERS TO HOME AND COMMUNITY-BASED WAIVERS, IT MAY JEOPARDIZE MICHIGAN'S CASE MANAGEMENT PLAN AMENDMENT. ACCORDING TO THE RESPONSE WE RECEIVED FROM HCFA AND OUR OWN REVIEW OF RECENT LEGISLATION CONCERNING CASE MANAGEMENT SERVICES, INCLUDING COBRA, WE THINK THE RECENT AMENDMENTS DID NOT HAVE THE EFFECT FEARED BY MS. ABRAMS.

PRIOR TO THE AMENDMENT, STATES COULD PROVIDE CASE MANAGEMENT SERVICES UNDER FREEDOM-OF-CHOICE OR HOME AND COMMUNITY-BASED SERVICES UNDER WAIVERS TO STATE PLAN REQUIREMENTS GRANTED BY THE SECRETARY OF HHS AS AUTHORIZED UNDER SECTION 1915(B) AND 1915(C) OF THE SOCIAL SECURITY ACT. 42 U.S.C. SEC. 1396N(B)-(C). STATES COULD ALSO RECEIVE ADMINISTRATIVE FUNDS UNDER THEIR MEDICAID PLANS FOR CERTAIN CASE MANAGEMENT ACTIVITIES SUCH AS PRE- ADMISSION SCREENING WHEN OFFERED TO ALL MEDICAID BENEFICIARIES IN ALL AREAS OF THE STATE.

SECTION 9508 ALLOWS STATES THE OPTION OF AMENDING THEIR STATE PLANS TO COVER CASE MANAGEMENT SERVICES WITHOUT REQUIRING THAT THE SERVICES BE AVAILABLE THROUGHOUT A STATE AND WITHOUT REQUIRING THAT COVERED SERVICES BE EQUAL IN AMOUNT, DURATION AND SCOPE FOR CERTAIN MEDICAID BENEFICIARIES. THIS CHANGE WAS ADDED TO SECTION 1915 OF THE MEDICAID LAW EVEN THOUGH IT PROVIDES AUTHORITY TO STATES TO AMEND THEIR PLANS WITHOUT GETTING A WAIVER. IT WAS APPARENTLY PLACED IN THIS SECTION TO MAKE IT OPTIONAL RATHER THAN A STATE PLAN REQUIREMENT UNDER SECTION 1902(A). HCFA'S INTERPRETATION, WHICH IS SUPPORTED BY THE LEGISLATIVE HISTORY, IS IN ACCORD WITH THIS VIEW. SEE H.R. REP. 453 (CONFERENCE REPORT), 99TH CONG., 1ST SESS. 545-46 (1985).

MOREOVER, UNDER THE TAX REFORM ACT OF 1986, PUB.L. NO. 99-514, 101 STAT. *** (1986), TECHNICAL AMENDMENTS TO COBRA RELATING TO THE MEDICAID PROGRAM CLARIFY CASE MANAGEMENT FURTHER. CASE MANAGEMENT SERVICES ARE NOW CLASSIFIED AS MEDICAL ASSISTANCE WHICH MAY BE PROVIDED FOR UNDER A STATE PLAN. SECTION 1905(A); ID., AT SECTION 1895(C)(3). HCFA ALSO NOTES THAT SECTION 9411(B) OF THE OMNIBUS BUDGET RECONCILIATION ACT OF 1986, PUB.L. NO. 99-509, 101 STAT. *** (1986), AMENDED SECTION 1915(G)(1) TO PROVIDE THAT A STATE MAY LIMIT CASE MANAGEMENT SERVICES TO INDIVIDUALS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS), WITH AIDS-RELATED CONDITIONS, OR WITH CHRONIC MENTAL ILLNESS.

WE HOPE THAT THE FOREGOING INFORMATION WILL ENABLE YOU TO RESPOND TO YOUR CONSTITUENT.

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