In response to my 6/25/2015 appeal for comments to CMS-2390-P (especially the section that explains how the parents of disabled children can be held financially responsible for the repayment of the cost of treatment delivered to their disabled child if they lose the final appeal of a Managed Care Organization’s denial of funding), I received the following e-mail message from an advocate.
The federal regulations have long allowed states to recoup the cost of services provided pending appeal if the family loses the appeal. See 42 CFR 431.230. Thankfully, Pennsylvania has never, to my knowledge, taken advantage of this provision. The proposed regulations and commentary say that if states choose to take advantage of this long-standing provision, they should say so in the MCO contracts and be consistent between FFS and managed care.
The proposed regulations you refer to are very lengthy (with the commentary, several hundred pages), and cover many, many, important topics. If [our organization] submits comments on them and urges others to comment, I will let you know.
Thanks for the clarification but the CMS requested comments on 438.420 (which affirms the appropriateness of making the recipients of services financially liable if they lose the final appeal). That’s wrong, no matter how long it’s been “on the books.” CMS could fix 431.230 if they felt compelled to, and that’s why the comment process is so important.
Slavery was “on the books” for 87 years before it was challenged and finally repealed. Some people still think that was a mistake.
It is wrong to hold the parents of a child who is a Medicaid recipient financially liable for the cost of the treatment services provided to their child while an appropriate, conscientious appeal of an adverse funding decision is underway. Perhaps that’s why Pennsylvania has never done it. They know it’s wrong. I know it’s wrong. The comment period is the place to express outrage over it, no matter how long it’s been “on the books.” Evil doesn’t improve, or stay the same, with age – it gets more dangerous as time passes because it can spread.
This comment period is the time and place to put an end to the evil threat of making parents of Medicaid recipients financially liable while they are fighting for the lives of their children. It should have been stopped, no matter which section(s) it appeared in, many years ago. Don’t you agree?
Here is a link to the CMS-2390-P proposed rule changes. You can see the 8 comments I’ve uploaded there so far, and the 23 comments received thus far (more than 600 comments were received the last time CMS proposed major changes to the Medicaid Act). The present set of changes is lengthy, but it is at least as important as the set of changes that received over 400 comments by this point in the two-month comment period (which expires on July 27th). This set of changes is flying way, WAY under the radar: