The September 7, 2007, Federal Register posting of the proposed regulations (CMS-2287-P ) indicates the proposed rule is estimated to reduce federal Medicaid outlays by $635 million in Fiscal Year (FY) 2009 and by $3.6 billion over the first five years (FY 2009–13). If adopted, California stands to lose more than $130 million annually in federal reimbursements for administrative responsibilities and certain home-to-school transportation services to students with disabilities (See August 18, 2007 Fiscal Report Article entitled, “Fight Continues on Proposed Federal Medicaid Regulations). The proposed rule would become effective October 1, 2008.
The CMS, under the umbrella of the federal Office of Health and Human Services, has consistently argued that the program is fraught with fraud and abuse, citing examples in New York and Michigan . Those claims have been strongly disputed by school agencies in those states. In response, President Bush eliminated the funding in his 2008 Federal Budget, and CMS started developing the regulations. However, the President’s proposed cuts have been rejected by the Democratic Congress, which has supported legislation to tighten up program requirements instead. The battle now moves to Congress; it will need to get language into a “veto-proof” bill to prevent the regulations from being implemented.
The comment period has begun and will end on November 6, 2007. CMS is charged with reviewing the comments and preparing a final rule. California and national education groups are preparing comments for submission and school agencies are also being encouraged to submit comments. Comments can be submitted in one of three ways:
2. By regular mail. Mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2287– P, Mail Stop S3–14–22, 7500 Security Boulevard , Baltimore , MD 21244 . Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. Send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2287–P, Mail Stop S3–14–22, 7500 Security Boulevard , Baltimore , MD 21244 .
A copy of the proposed regulations can be found at:
- -Students with special needs already have a number of cards stacked against them. Their families do too, in many cases, including financial and time constraints. It seems wrong to me to cut back services for this particualr population.
- -Is it ultimately the school district's responsiblity to provide transportation for special education students, and they have pawned off that responsibility to the federal government through a Medicaid-based loophole? If so, any anger directed toward CMS for this would be better oriented toward the school districts to begin with.
- -Notice the wording of the document we received. In quintessential, uber-liberal, teachers-union-backed form, the author implicates the Republican administration as the culprit, and the Democratic congress as the potential savior. Puh-lease - this is not a partisan issue, and if the power roles were reversed then precisely the opposite scenario would prevail. I grow incredibly weary of the insertion of partisan political gamesmanship into issues such as this, when basically the entire government is at fault. It is astounding to me that, considering the taxes collected by the government for just the activities of my one family - including sales tax, vehicle tax, property tax, income tax, captial gains tax, etc, etc, etc - the school district cannot afford to transport one of my three kids back and forth to school. It boggles the mind and offends the intellect. And it transcends political party. And the political discussion would be incomplete if it did not also include the educators' various unions.
- -If you take the time to read the linked document, you may come away with the feeling, as I did, that the CMS may have a legitimate beef with the way schools are billing Medicaid. It says:
"CMS has long-standing concerns about improper billing by school districts forSo let me get this straight. Because the school districts improperly (fraudulently) claimed excessive administrative costs (does anyone doubt the truth of this?), we are now facing a situation where transportation could be cut off for special needs kids? My family will work around it if indeed it happens this way - other families may not be as blessed as mine. Other kids have disabilities requiring much more complex and expensive transportation considerations than mine. Other kids may be being raised by a single parent who has work schedule conflicts. Some families may not have the financial means to own a vehicle to get their kid to school (in which case they probably should have waited until better financial times to have a child, but that is a rant for another day). I hope the administrators who robbed the system lose at least one night of sleep over the results of their actions. But its not likely they will.
administrative costs and transportation services. The U.S. Department of
Health and Human Services Office of the Inspector General and the Government
Accountability Office have identified these categories of expenses as
susceptible to widespread fraud and abuse ... In fact, examining
State-reported expenditure related to schools reveals that, in certain years, a
number of States' reported school-based administrative expenditures approached
or even exceeded their reported school-based direct medical service
expenditures, which is clearly evidence of improper claiming in this area."
- -Is there not a better way to distribute these funds? In other words, any given dollar that is collected from a taxpayer that eventually ends up being spent on Special Ed transportation is passing more desks, obviously, than is necessary. The money, apparently, is going from the Federal general fund to the State general fund, from there to the Medicaid general fund, then to the school district general fund, where it is appropriated to transportation costs. How many pennies are sucked out of each dollar at each step of the way? Is the tax-collected dollar worth, in your estimation, 90 cents of transportation? 43 cents? 7.5 cents? I have no idea, but I'm guessing 7.5 is closest to accurate. If I ran my business like this system is being run, I'd have to close up shop tomorrow.
If there is one thing I love about blogging, it is finding out via comments how many people agree or disagree with me.
Also, please note that the proper means to submit comments are included at the end of the school's email. If you would like to have input on this, this is your chance. The comment period lasts until November 6.