Medicaid Community-based
Attendant Services And Supports Act
of 2003
S. 971
H.R. 2032
MiCASSA - A Summary
MiCASSA gives people
real choice in long term care options by reforming
Title XIX of
the Social Security Act (Medicaid) by ending the institutional
bias. MiCASSA allows
individuals eligible for Nursing Facility Services or
Intermediate Care
Facility Services for the Mentally Retarded (ICF-MR) the
opportunity to choose
instead a new alternative, "Community-based Attendant
Services and Supports.”
The money follows the individual!
In addition, by providing
an enhanced match and grants for the transition to
Real Choice before
October 2005 when the benefit becomes permanent, MiCASSA
offers states financial
assistance to reform their long term service and
support system to
provide services in the most integrated setting.
Specifically what does this bill do?
1) Provides community-based
attendant services and supports ranging from
assistance with:
activities of daily
living (eating, toileting, grooming, dressing, bathing,
transferring),
instrumental activities
of daily living (meal planning and preparation,
managing finances,
shopping, household chores, phoning, participating in the
community),
and health-related
functions.
2) Includes hands-on
assistance, supervision and/or cueing, as well as help
to
learn, keep and enhance skills to accomplish such activities.
3) Requires services
be provided in THE MOST INTEGRATED SETTING
appropriate to the needs of the individual.
4) Provides Community-based
Attendant Services and Supports that are:
based on functional
need, rather than diagnosis or age;
provided in home or
community settings like -- school, work, recreation or
religious facility;
selected, managed
and controlled by the consumer of the services;
supplemented with
backup and emergency attendant services;
furnished according
to a service plan agreed to by the consumer;
and that include voluntary
training on selecting, managing and dismissing
attendants.
5) Allows consumers
to choose among various service delivery models
including vouchers, direct cash payments, fiscal agents and agency
providers. All of these models are required to be consumer controlled.
6) For consumers
who are not able to direct their own care independently,
MiCASSA allows for “individual’s representative” to be authorized by
the
consumer to assist. A representative might be a friend, family member,
guardian, or advocate.
7) Allows health-related
functions or tasks to be assigned to, delegated to,
or
performed by unlicensed personal attendants, according to state laws.
8) Covers individuals’
transition costs from a nursing facility or ICF-MR
to a
home setting, for example: rent and utility deposits, bedding, basic
kitchen
supplies and other necessities required for the transition.
9) Serves
individuals with incomes above the current institutional income
limitation -- if a state chooses to waive this limitation to enhance
the
potential for employment.
10) Provides
for quality assurance programs which promote consumer control
and satisfaction.
11) Provides
a maintenance of effort requirement so that states can not
diminish
more enriched programs already being provided.
12) Allows enhanced
match (up to 90% Federal funding) for individuals whose
costs exceed 150% of average nursing home costs.
13) Between 2001 and
2005, after which the services become permanent,
provides enhanced
matches (10% more federal funds each) for states which:
begin planning activities
for changing their long term care systems, and/or
include Community-based
Attendant Services and Supports in their Medicaid
State Plan.
SYSTEMS CHANGE
14) Provides grants
for Systems Change Initiatives to help the states
transition from current
institutionally dominated service systems to ones
more focused on community
based services and supports, guided by a Consumer
Task Force.
15) Calls for national
5 to 10 year demonstration project in 5 states to
enhance coordination
of services for non-elderly individuals dually eligible
for Medicaid AND Medicare.
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