FEINGOLD/CASA COMPARISON
Prepared by:
Topeka Independent Living Resource Center
Includes:
"Long Term Care Reform & "Medicaid Community
Deficit Reduction Act" Attendant Services Act of
(Feingold bill S. 879) 1997" (H.R. 2020/CASA)
* First and foremost, the * Amends Title XIX of the
plan is optional for Social Security Act
States, which retains the (Medicaid) and creates a new
status quo. (It is and mandatory Medicaid
currently an option within service - "Qualified
the medicaid laws for states Community-Based Attendant
to provide community-based Services " (QHCBS)
services). If a state
chooses to have a Plan under * Each state shall develop a
this optional. long term care services
transition plan with major
* Title I 101(b) of the participation by the State
Feingold bill states Independent Living Council,
"Nothing in this title shall the State Developmental
be construed to create a Disabilities Council and
right to services for Councils on Aging.
individuals or a requirement
that a State with an * This plan must have
approved plan expend the specific action steps and
entire amount of funds to timetables to increase the
which it is entitled under proportion of HCBS provided
this title" in the state.
* If a State chooses to
develop a plan under the
Feingold bill, it must do so
according to the following
criteria.
SERVICES SERVICES
* States determine which * Establishes QHCBS as
HCBS services they will mandatory under Title XIX of
offer. There is no the Social Security Act,
requirement as to what just as nursing home and
services they have to have, other services are currently
is up to each individual mandatory.
state.
* The services contained in
* The services the bill CASA are attendant services
talks about are: furnished to an individual
1. Personal care services a. on an as-needed basis
2. HCBS b. in a home or community
(a) homemaker and chore based setting
services, c. under an agency-provider
(b) home modifications, or other model
(c) respite, d. selected, managed &
(d) assistive tech., controlled by the individual
(e) adult day services, e. includes health related
(f) habilitation and tasks which can be
rehabilitation, delegated, assigned to and
(g) supported performed by an unlicensed
employment, attendant
(h) home health, f. any other option under
(I) transportation, medicaid (includes those
(j) any other care or listed opposite as HCBS)
assistive services specified
by the State and approved by * Services included-
the Secretary a. back-up and emergency
3. Home and community care attendant services
furnished to functionally b. voluntary training on how
disabled elderly individuals to select, manage, and
4. Community supported dismiss attendants; and
living c. health-related tasks that
5. Services furnished in a are assigned to, delegated
hospital, nursing facility, to, or performed by,
ICF-MR, or other unlicensed personal
institutional setting. attendants.
* Services may be delivered * Services can be provided
in a person's home, a range in a home or community-based
of "community residential setting to include a school,
arrangements", or outside workplace, recreation or
the home. (Community religious facility.
residential arrangements is Specifically excludes a
not defined.) nursing facility, an ICF-MR,
or other institutional
* Determination of facility.
disability and plans or care
reviewed every 6 months. * Plans of care reviewed as
is already provided for
under current law.
PLANS OF CARE PLANS OF CARE
* Developed by assessor, * Based on an assessment of
individual (or his/her functional need and agreed
representative) and approved to by the person receiving
by the individual the services.
(or her/his representative).
* "Care management" services
are to be provided by a
public or private entity
that does not provide HCBS.
(some exceptions to this
rule).
ELIGIBILITY ELIGIBILITY
* In general, anyone with a * If an individual meets the
disability can be screened requirements to be eligible
without limitations on for Nursing Facility
eligibility based on income Services or Intermediate
or age. Through 2007 a state Care Facility Services for
can limit eligibility based the Mentally Retarded, that
on severity of disability person has the choice to use
and the plan may limit QHCBS. The money would
eligibility based on the follow the individual and be
definition of "institutional used for the services the
setting" as defined by the individual chooses.
State.
* Continuation of services * QHCBS based on an
are provided for someone who assessment of functional
is already receiving medical need.
assistance under Medicaid.
* The individual is screened * Under current law,
by a public agency to assessors can also provide
determine if the individual services.
is a person with a
disability. (Assessors * States already have the
cannot be providers.) To option to provide services
qualify the individual would to those indicated opposite.
have to meet the following The criteria, opposite, are
criteria: similar to those for ICF/NF
1. Requires hands-on or eligibility.
standby assistance,
supervision, or cueing with
3 activities of daily living
(ADL) for more than 180 days.
2. Have a severe cognitive
or mental impairment who
requires supervision for
health and safety reasons,
or due to symptoms of 1 or
more serious behavioral
problems.
3. Severe or profound MR.
4. Someone who needs
assistance to manage their
medical or nursing care.
5. Children under 6 with
same disabilities.
* No more than 5% of the * CASA doesn't include such
State's allotment for a percentage exclusionary
services can go to people criteria. Anyone eligible
with severe disabilities, for ICF or NF services
that are comparable, in would be eligible for CASA.
severity to those
described above, but don't
meet the criteria.
* The Plan would have to * funding currently
specify how services are/ available for institutional
will be allocated among care would be available for
eligible individuals across QHCBS
all eligible groups (1 thru
5 above.) The Plan "shall
attempt to meet the needs of
individuals..within the
limits of available funding."
* The Plan shall provide * Requires services to be
for consumer choice provided in the most integrated
regarding services and setting.
and providers "to the
extent feasible."
SERVICE PROVIDERS SERVICE PROVIDERS
* State enters into a * The consumer may be
contract with an agency to employer of the attendant
act as the employer of the and can choose an agency to
home-care provider, although be the payroll agent. The
the service recipient shall consumer has control within
retain the right to select, a continuum of options to
hire, terminate, and direct self-direct.
the work of a provider.
* Shall include both agency- * allows health-related
administrated and consumer- tasks to be assigned to,
directed personal assistance delegated to, or performed
services, but can't limit by unlicensed personal
benefits to services attendants.
provided by professional
providers. The State
specifies any requirements
for participation for each
type of provider. However,
States cannot subject
providers to any kind of
license that the Secretary
does not find necessary to
health and safety.
* After 2005, no more than
10% can go towards
administrative costs.
* Must provide for a single * would use the same access
point of access to apply for points as are available
program. This currently.
notwithstanding, the
plan may designate separate
points of access for
appropriate classes of
individuals.
* Before the Plan can be * no provision under CASA.
implemented, the State must
enter into negotiations with
the labor unions
representing the employees
of affected facilities and
discuss the impact of the
plan on the workforce and
methods to redeploy workers
to positions in the proposed
system.
* PA services are mandatory * Attendant services are
in the State Plan and are mandatory in CASA. Any
the only services that are service under CASA/
self-directed. The agency Medicaid could be self
in charge of the directed.
individual's "Care
Management" directs all
other services.
* Payment - the State can * vouchers. direct cash
provide for vouchers, cash payments, fiscal agents and
to individuals, agency providers are
capitalization payments to delivery options in CASA
health plans, and payment
to providers in their Plan.
COST SHARING COST SHARING
* The Plan can provide for * States may impose a spend
cost sharing and/or an down and/or an annual
annual deductible. deductible.
* covers individuals with
incomes above the current
Medicaid income limitation
if a state chooses to waive
this limitation because of
increased potential for
employment.
QUALITY ASSURANCE QUALITY ASSURANCE
* State will establish a * A program must be
plan to monitor quality established and maintained
which will include consumer that is developed after
input and surveys; optional public hearings and is
training on how to hire, based on consumer
fire and manage PA's; satisfaction. States must
minimum competency survey and certify
requirements for agency (unannounced) agency
provider employees who providers. Minimum
provide direct services; qualification standards for
minimum standards for agency providers, financial
providers, appeals for operating standards and a
eligibility denials and consumer grievance process
grievance procedure, along would be included.
with others.
SAFEGUARDS SAFEGUARDS
* The State Plan will * Each state's advocacy &
establish a Client Advocacy protection offices, along
Office. with CIL's and other state
and federal organizations
currently in place would
monitor. States would allow
for monitoring boards
consisting of parents,
providers, consumers and
neighbors. The same
safeguards as required in
community service living
arrangements (CSLA) would
apply.
* Rights of Consumers: Right * These same rights are
to be fully informed in already contained in current
advance, orally and in law
writing, of any changes in
care to be provided and to
participate in planning care
or changes in care. If the
individual is incompetent,
the guardian would be
informed.
Also have the right to voice
grievances as to services or
lack thereof without
reprisals; be told how to
complain to authorities; and
for prompt resolution of
grievances.
ADVISORY GROUPS ADVISORY GROUPS
* A Federal Advisory Group * Would use groups currently
would be established in place specifically
composed of people with including SILCs, DD councils
disabilities and their and councils on aging.
representatives.
* State's will establish
their own advisory groups
made up of political
appointees, individuals with
disabilities and their
representatives. This group
would establish the State
plan.
HOSPITAL LINKAGE PROGRAMS TRANSITION TO HOME SETTING
* Grants to entities who * To make the transition
would undertake discharge from a nursing facility or
planning for the purpose of intermediate care facility
ensuring that home and for the mentally retarded to
community based options a home setting, expenditures
would be made available to may be made for transition
people coming out of acute costs, such as rent and
care/rehabilitation settings utility deposits, first
instead of only planning to month's rent and utilities,
discharge into a nursing bedding, basic kitchen
home. supplies, and other
necessities required.
FUNDING FUNDING
* would establish changes in * Funding currently
funding for Nursing available for institutional
Facilities who would be care would be available for
caring for people with people choosing QHCBS. In
disabilities with heavy addition $2 billion dollars
needs. would be appropriated over 6
years to help states
* new federal funding would transition from
be phased in over 9 years institutional to community-
starting in 1999 and the based services (and see
total would be $5 billion in above).
the year 2007.
* State P & A's would * funding for state P & A's
receive 1/2 of 1% for would remain as it is
advocacy services (in the currently under the law.
states that had the plan).