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DRNM, Allies Seek Fixes to DD Waiver Changes
DRNM, The Arc of New Mexico, and a few private attorneys have asked the Department of Health and the Human Services Department to postpone implementation of key aspects of the planned re-design of the Developmental Disabilities Waiver program.

In our joint letter dated November 30, 2012, we noted the high percentage of waiver participants who have been assessed as having minimal needs and who will thus face reductions in services and the elimination of residential services.  The elimination of "outliers" funding, along with service limits on those with higher needs will discriminate against those with more severe disabilities.  The letter also challenges reductions in therapy services, violation of due process requirements, and other problems with the latest DD waiver regulations.

As noted below, the new version of the waiver program is scheduled for implementation in January.  For a copy of the joint letter, click here.

Health Care Reform ("Obamacare"): What does it mean for people with disabilities?
The Disability Coalition issued a series of brief bulletins this summer on the provisions of the Affordable Care Act ("Obamacare") that are of particular interest to persons with disabilities.  Jump to The Disability Coalition section of DRNM's web page to access these informative bulletins.

New Mexico DD Waiver Changes Postponed
The state Department of Health (DOH) announced on August 24, 2012, that it is postponing implementation of new DD waiver program changes and provider rate changes until January 1, 2013. Click here for the text of the announcement from DDSD Division Director Cathy Stevenson.

Based on subsequent information from DOH, it now appears that waiver participants whose annual plans and budgets renew before March 1, 2013, will get another full year of service based on the “old” (current) service system and rate structure.  Those whose annual review date comes on or after March 1 will have a service plan based on the new model of services and provider rates.  In January, ISP teams will start working to develop new service plans and budgets for those whose review date is in March, so that plans and budgets can be approved and implemented at that time.

For information about timelines that is being given to individuals, family members, providers, and casemanagers and is displayed on the DDSD website, click here.

The revised DD waiver program will be based on a new assessment tool (the Supports Intensity Scale, or “SIS”) to identify the service needs and budget allocations of persons on the waiver. Some service definitions are changing, and rates to be paid to provider agencies are changing.  The criteria for determining who will receive residential services (including Family Living) are being revised, and some will no longer qualify.  New limitations are being imposed on the number of hours of therapy (OT, PT, SLP) that can be provided, with an emphasis on having direct care staff carry out therapeutic exercises and activities.

For more information about the DD waiver changes from DRNM's perspective, click here.  For information from the Department of Health about the new service and budget model, click here.  DRNM submitted comment to the New Mexico Human Services Department on the proposed regulatory changes to the Developmental Disabilities (DD) Waiver program.  Click here for the full text of the letter which details our concerns.

DRNM is still collecting information on the impact of the waiver changes. If you or a family member participates in the DD waiver, please fill out our survey on your experiences with the new Supports Intensity Scale (SIS) evaluation tool.  Click here to link to the survey.

Proposed Overhaul of Medicaid Program
DRNM, Disability Coalition Submit Comments to CMS
New Mexico's Human Services Department (HSD) has revised and re-submitted a request for federal approval of a plan that would significantly change the state's Medicaid program.  The proposal - called an 1115 waiver application and scheduled to go into effect in January 2014 - would consolidate virtually all the Medicaid services that are now provided separately through physical health managed care ("Salud"), behavioral health managed care (through Optum Health), and long term services managed care ("CoLTS").  HSD calls the proposed new system "Centennial Care".  Services currently provided through the Developmental Disabilities waiver will not be included in the new program, but DD waiver participants will have to get their basic health care services through the new plan.  Changes to the DD waiver are being done separately by DOH.  See the notice above.

There are many positive as well as negative aspects of the state's revised plan.  Of particular interest to the disability community are the changes to long-term services.  The good news is that it would allow most people who are already on Medicaid and who meet the nursing home level of care to receive services that are now available only through the "CoLTS-C" (Disabled and Elderly) waiver, without having to be in a "slot" in that program.  This would significantly increase the number of people who could receive these services.  It would also free up waiver slots for some of those who are on the waiting list for the waiver program.  The bad news is that the state is proposing to limit the amount of such services that people could get in the new program, to no more than the cost of nursing home care.  For some Medicaid recipients with severe disabilities, this may mean there is no viable alternative to nursing home placement, and that may well violate the ADA.

It is now up to CMS - the federal agency that is reviewing the state's application - to approve the proposal or not, and to determine what changes, if any, will need to be made before such approval might be given.  DRNM and The Disability Coalition teamed up to provide lengthy and detailed comments on the state's proposal, calling on CMS to require a variety of improvements and clarifications to "Centennial Care" prior to federal approval.  Click here for a copy of the Coalition/DRNM letter.  The public comment period for CMS has come to an end, and many individuals and organizations also provided input to CMS.  Click on the following highlighted links for DRNM's summary and analysis of the revised proposal or for the full text of HSD's 1115 waiver application.