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Medicaid Community Attendant Services And Supports Act of 1999

MiCASSA: A Summary

MiCASSA gives people real choice in long term services.  Amending Title XIX of the Social Security Act (Medicaid), it creates an alternative service: Community Attendant Services and Supports.  MiCASSA allows individuals eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded (ICF-MR) the choice to use these dollars for Community Attendant Services and Supports.  THE MONEY FOLLOWS THE INDIVIDUAL!

Specifically what does this bill do?

1)  Provides community attendant services and supports ranging from assisting with activities of daily living (eating, toileting, grooming, dressing, bathing, transferring) instrumental activities of daily living (meal preparation, managing finances, shopping, household chores, phoning, community participation), and health-related functions. 

2)  Includes hands-on assistance, supervision and/or cueing, as well as help to learn, keep and enhance skills to do such activities.

3)  Requires services be provided in THE MOST INTEGRATED SETTING appropriate to the needs of the individual.

4)  Provides Community Attendant Services and Supports that are:

• based on an assessment of functional need;

• 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 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 which are required to be consumer controlled.

6)  For consumers who are not able to direct their own care independently, MiCASSA allows for the "individual's representative" to be authorized by the consumer to assist.  This might be a friend, family member, guardian, or advocate. 

7)  Allows health-related functions to be assigned to, delegated to, or performed by unlicensed personal attendants, according to state law.

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)  Allows states to limit the aggregate amount spent on long term care in a year to that amount the state would have spent on institutional services for such eligible individuals In the year.

12)  Provides a maintenance of effort requirement so that states can not diminish more enriched programs already being provided.

REAL CHOICE SYSTEMS CHANGE

1)  MiCASSA provides grants for Real Choice Systems Change Initiatives to help the states transition from current institutionally dominated service systems to ones more focused on community services and supports. 

2)  Each state will create a Consumer Task Force to develop a plan for transitioning services into a more community oriented system.  A majority of the members must be people with disabilities or their representatives. 

3)  The Secretary of Health and Human Services, along with the National Council on Disabilities, will review regulations and report to Congress on how to reduce excessive use of medical services.  The Secretary will also establish a task force to examine financing of long term services.