An analysis about the pending TCM rules that was forwarded by the Maine advocate to the NDRN National Disability Rights Network, which is the National Protection and Advocacy organization out of DC.

Case Management

December 20, 2007 —The Centers for Medicare and Medicaid Services (CMS) has published interim final regulations to govern case management services under Medicaid (Federal Register, December 4, 2007, Vol. 72, No. 232, 68077-68093; 42 CFR Parts 431, 440 and 441). Under Medicaid, case management services are services that will assist individuals in gaining access to needed medical, social, educational or other services.

View the latest memo from Center for Medicare and Medicaid Services (CMS):

CMS Regulation Status

These regulations were promulgated to implement part of the Deficit Reduction Act of 2005 (DRA, Public Law, 109-171—see the Bazelon Center's March 2006 Mental Health Policy Reporter) and are CMS' final interpretation of Section 6052, Reforms of Case Management and Targeted Case Management. The DRA made substantial changes to many vital federal programs, including Medicaid, Medicare and TANF; with an overall focus on saving the federal government money.

Section 6052 of the DRA outlined specific provisions on what may be included in case management.  It also clarified that Medicaid will not pay for certain services that have traditionally been furnished by child welfare system case managers. Additionally, it appeared to restate Medicaid's prohibition on payment for services for which another party is liable (third-party liability) to pay for the service. However, it also stated this third-party payment exclusion applied to potential reimbursement under a "medical, social, educational or other program."  There was no further definition of what this exclusion encompasses.  Our March 2006 Policy Reporter offers an analysis  of the DRA and section 6052).

The Congressional Budget Office estimated that the case management changes in the DRA would save $760 million over five years.  The estimate of savings resulting from this interim final regulation is far higher — $1.28 billion over five years.

See a summary of the regulation, its potential impact, and links to text and PDF  versions of the regulations at www.bazelon.org/issues/medicaid/takeaction/TCMRegsSummary12-20-07.htm.

Public Comments Encouraged

The rules allow for a 60-day public comment period (ending at 5 p.m. on February 4, 2008). They become effective on March 3, 2008—90 days after their publication in the Federal Register.  Although final on an interim basis, the rules can be modified prior to the effective date. Accordingly, advocates should submit comments to increase the likelihood of modifications (click here on how to submit comments).

Watch our website after the holidays for a sample comment letter from the Bazelon Center, which you may use to help shape your comments.