Senate hearing reviews changes to medical eligibility assessments to reduce wrongful terminations
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Summary
SB 6 12 would modify clinical eligibility criteria for long-term care and expand who may provide determinations; DHHS reported shrinking the Medical Eligibility Assessment from 14 to three pages, piloting case-manager attestations for redeterminations, and targeting vendor and IT changes for a July 1 rollout, while advocates urged an interim moratorium on terminations.
Senator Kevin Avard introduced SB 6 12 to amend long-term care eligibility rules by adding mobility to activities of daily living considered for level-of-care determinations and by broadening who may provide clinical input (physicians, physician assistants or APRNs and other health providers).
Representatives from DHHS described a stakeholder-driven process that reduced the Medical Eligibility Assessment (MEA) from roughly 14 pages to a proposed three-page instrument focused on the medical eligibility standard in HEM 802. DHHS said it is pursuing CMS guidance and plans to issue a solicitation for a new MEA vendor with a target contract start of July 1; the department also described automation and IT improvements to streamline scheduling, consent and data integration.
Home care providers and advocates described clients who lost services during prior administrative transitions and urged safeguards. Amy Moore (Accenture Care Alliance) reported dozens of clients whose services lapsed and urged an interim pause on terminations while new processes and the vendor are implemented; Cheryl Steinberg (Legal Assistance/Justice and Aging Project) and others said notices and appointment scheduling procedures need stronger protections to avoid erroneous closures of vulnerable people.
DHHS acknowledged prior problems, described corrective oversight (case-management outreach when redeterminations appear likely to result in closure) and said it had denied 26 people through the period referenced but has instituted additional supervisory review before terminations. Senators asked whether DHHS could provide an interim moratorium or clear protections until the July 1 changes take effect; department staff said they would consult and consider specific safeguards.
