Mark Moody, President
Eleanor White, Past PresidentMark King, President – Elect
Anthony S. Thaxton, Ph.D., Executive Director,
4769 Crestridge Ct. Holland, Mi 49423
Phone: 616.335.2411 Fax: 616.335.2811
E-Mail:
March 7, 2008
The Honorable Carl Levin
United States Senate
269 Russell Senate Office Building
Washington, D.C. 20510-2202
Dear Sir,
This letter is submitted on behalf of the Michigan Association of Administrators of Special Education, a professional organization of nearly 500 administrators in local and intermediate school districts who are responsible for coordinating the delivery of special education programs/services to over 244,000 students with disabilities throughout the state of Michigan. The purpose of this letter is to express our serious concern over the interim final rules impacting the Centers for Medicare and Medicaid Services (CMS). The new rules include significant cuts to the school-based Medicaid program.
We understand the intent of the new regulations is to reduce any excesses in the number of case managers for an individual student who is served by multiple agencies. But we also feel that targeting schools for reduction of case management by exclusion of activities that are explicitly included by law is inappropriate.
1. We agree with the analysis by the Council for Exceptional Children (CEC), the National Governors’ Association (NGA), the National Association of State Medicaid Directors (NASMD) and others that elimination of many case management activities for Individualized Education Program / Individualized Family Service Plan (IEP/IFSP) development conflicts with Title XIX of the Social Security Act. The Act clearly states that reimbursement cannot be denied for assistance for covered services based on the fact that the services are part of an IEP/IFSP. In numerous instances the regulations are an attempt by the administration not to implement or clarify, but to circumvent legislation.
2. The new cuts and burdens go well beyond the stated intents and policies in the Deficit Reduction Act of 2005. Projections from the U.S. House Committee on Oversight and Government Reform indicate that funding cuts will be about three times higher than the estimates used to craft new regulations. Across Michigan, the school share of state Medicaid revenue was $67.1 million, of which over $30 million comes from case management activities now targeted for elimination. Loss of Medicaid support for case management will mean the funding burden will be shifted to state and local sources that are already struggling with proposed cuts to administrative outreach and transportation.
3. We feel that limitations in the new regulations stem from a perspective that schools are a secondary agency for the provision of medically related services to children. This stands in contrast to the position of the U.S. Department of Health and Human Services “that schools represent ‘the single best link’ for identifying and enrolling eligible low-income children in public health coverage”. Toward that end, Michigan schools have enjoyed a strong development of multidisciplinary and medically related special education services such as speech/ language, physical, or occupational therapy services. These services consist of teachers (who act as Medicaid case managers) working with the medically related service providers. This development of quality services, however, has significantly shifted medical service burdens for children to the schools. For many children, initiation of these medically related services leaves the school as the sole provider for any such services many children will receive. We feel that the regulations should at least allow for multiple case managers where children’s complex needs cross agency lines. Toward that end support is merited for case management at the child’s most important community service agency - the school.
To summarize, we strongly urge that state governmental departments exert whatever influence necessary to eliminate questionable regulatory barriers and support our ability and legislated duty and to deliver quality school-based medical services. At the very least, we need to extend the current moratorium on implementation of the new CMS regulations until a reexamination of these critical issues can be made. We would like you to support legislation to prohibit cuts to the School-Based Medicaid program without legislative approval.
Sincerely,
Anthony S. Thaxton, Ph.D.
Executive Director
Michigan Association of Administrators of Special Education