**[Introduction]{.smallcaps}**

The U.S. Department of Health and Human Services Office on Disability
(OD) convened a regularly scheduled Quarterly Constituent Input Meeting
on January 12, 2006, in the Deputy Secretary's Conference Room, Hubert
H. Humphrey Building, Washington, D.C. Over 40 constituent organizations
and HHS agencies and offices were represented, either in person of by
conference call.[^1] These quarterly meetings provide representatives
from the national disability organizations (representing 54 million
Americans with disabilities of all kinds) opportunity to have questions
answered and provide recommendations on HHS policy issues affecting
persons with disabilities.

CMS Administrator Dr. Mark McClellan, Gale Arden Director of CMS's
Disabled and Elderly Health Programs (Medicaid), and his senior staff
joined those in attendance at the meeting to provide an update on the
Medicare Prescription Drug Benefit plan, to discuss issues related to
Durable Medical Equipment, and to discuss and receive constituent input
into the Strategic Plan developed by the Medicaid Disabled and Elderly
Health Programs Group. This was the fourth constituent input meeting
focusing on CMS issues, including the Medicare Prescription Drug
benefit.

Office on Disability Director Margaret Giannini, MD, FAAP, opened the
meeting by welcoming those in attendance and asking participants in the
room and joining the meeting by telephone to

introduce themselves. She explained the ground-rules for the meeting.
Each participant was

asked to state at least one issue, and then to provide at least one
recommendation that responds to the issue raised. If time permitted,
participants had the opportunity to participate in a second round of
questions and answers.

**[Meeting Summary]{.smallcaps}**

The following provides a summary of the questions and comments of the
disability constituency organization representatives who attended the
meeting and shares the observations, comments and suggestions made by
CMS Administrator McClellan, Ms. Arden and other CMS staff, as well as
constituent responses and recommendations.

**[CMS Update]{.underline}**

CMS Administrator Mark McClellan, M.D., thanked all of the disability
constituency organizations that helped advocate for improvements in the
Medicare and Medicaid statutes to support community-based services for
beneficiaries, including new initiatives for long-term care support. He
noted that the Deficit Reduction Act provisions related to Medicare and
Medicaid, while not perfect, particularly with respect to funding
levels, move the programs in the right direction, particularly with
respect to expanded coverage and reduced rates of the uninsured. The
legislation currently is awaiting final passage in the House, which he
expects to occur by the end of the month or in early February.

He noted that he views this past year as a "transformational" year for
the delivery of services to persons with disabilities. Specifically, he
noted that the legislation includes specific provisions regarding "money
follows the person," cash/counseling, long-term care partnerships and
significantly enhanced options for home and community-based services. He
urged constituent organizations to be in touch with CMS on any
provisions about which they are concerned, particularly when it comes to
CMS interpretation of these new provisions under Medicare and Medicaid.

***Medicare Prescription Drug Benefit Plan***

Dr. McClellan expressed optimism about the new Medicare Prescription
Drug Benefit program. For those persons who have received their cards,
the program is working well; over one million prescriptions a day are
being filled.

However, he acknowledged that transition issues -- primarily with
respect to inappropriately high co-payments -- have occurred primarily
among persons who are dually eligible for Medicare and Medicaid or in
low-income subsidy status who switched plans close to the end of the
month and had not yet received their cards.

CMS has been working to address the issue in a systematic fashion,
working with the plans to identify and correct co-payment information
that is not accurate. At the same time, CMS is working to ensure that
systems and supports are in place to respond immediately to individuals'
prescription medication needs when a problem arises:

-   Beneficiaries can call a special response line (1-800-Medicare)
    directly for help with a problem.

-   Pharmacists have been alerted to a toll-free line to confirm a
    person's eligibility and co-payment status to help resolve problems.

Dr. McClellan urged those in attendance to be in touch with CMS
immediately with problems that have arisen to enable CMS caseworkers to
begin to resolve the problem. Most of these co-payment issues have been
able to be resolved in a single day.

***Questions and Answers on Prescription Drug Plan Issues***

Constituency organizations expressed ongoing support for the work to
date to move this complex program forward. They spoke of the CMS staff
who enabled constituency organizations to provide detailed information
to persons with disabilities about the program, and of the willingness
of CMS Administrator McClellan to work with them to sort out issues,
concerns, and solutions through forums such as the Office on
Disability's constituency input meetings.

*A NUMBER OF STATES ARE TEMPORARILY COVERING THE MEDICATION COSTS AS A
WAY OF RESOLVING CO-PAYMENT PROBLEMS FOR PERSONS WHO ARE DUALLY ELIGIBLE
WHO NEED THEIR MEDICATIONS IMMEDIATELY. WHAT CAN CMS SAY TO THOSE
STATES?*

States are encouraged to work directly with CMS to resolve difficulties
arising for persons with dual eligibility.

*SOME PLANS APPEAR TO BE UNWILLING TO COMMUNICATE WITH DESIGNATED
REPRESENTATIVES OF BENEFICIARIES --SUCH AS THOSE WITH DEVELOPMENTAL
DISABILITIES -- TO HELP RESOLVE DRUG BENEFIT PROBLEMS. WHAT CAN CMS DO
TO REMEDY THIS PROBLEM, PARTICULARLY SINCE SOME STATES HAVE MADE AND
EXTRA EFFORT TO ENSURE THAT PERSONS WITH DISABILITIES WHO HAVE
DESIGNATED REPRESENTATIVES TO ASSIST THEM?*

CMS will send out a general reminder to plans about the important role
designated representatives play, particularly for persons with
intellectual challenges, in the drug benefit process where problems are
being experienced in working with specific plans or in particular areas
of the country.

*WHAT IS BEING DONE TO HELP TO HELP PERSONS DURING THE TRANSISTION TO
THE MEDICARE DRUG BENEFIT PROGRAM, PARTICULARLY WITH RESPECT TO
CRITICALLY NEEDED MEDICATIONS THAT BENEFICIARIES MAY NOT BE GETTING?*

CMS has put out a letter to the drug plans on meeting urgent transition
needs; it should be of help. However, if particular cases come to the
attention of constituency organizations, CMS should be alerted so we can
help resolve the problems immediately.

*CLASS IV DRUGS (BENZODIAZEPINES) ARE NOT BEING COVERED UNDER THE
MEDICARE PRESCRIPTION DRUG BENEFIT IN TENNESSEE. WHAT CAN BE DONE ABOUT
THIS PROBLEM?*

Tennessee is the only state not covering this class of medications; it
is their option to do so. However, CMS does not expect any other states
or the District of Columbia to discontinue their coverage of this class
of medication.

*ANECDOTAL INFORMATION HAS REACHED CONSTITUENCIES THAT SOME PHYSICIANS
ARE CHARGING BENEFICIARIES \$5 A PRESCRIPTION FOR THE PURPOSE OF
FORMULATING MEDICATION APPEALS THROUGH THE EXISTING APPEALS PROCESS.*

The appeal process should be cost-free for beneficiaries; people should
be able to get through the appeals process without having to pay for it.
CMS will look into this issue.

*FOR THE 2007 DRUG PLAN CONTRACT YEAR, WILL EXISTING FORMULARY POLICIES
REGARDING CERTAIN CLASSES OF MEDICATION BE REVISITED?*

The draft formulary guidance for the 2007 contract year will be
published soon. There will be a short public comment period, followed by
the final guidance in early March. This will address all of the
formulary policies for 2007.

*WHEN A DUALLY ELIGIBLE BENEFICIARY IS ENROLLED (OR ENROLLS) IN THE
MEDICARE DRUG BENEFIT PROGRAM, THERE IS A POSSIBLITY THAT HIS OR HER
SPOUSE WILL LOSE PREVIOUSLY AVAILABLE PRIVATE COVERAGE. WHAT CAN CMS DO
TO ADDRESS THIS ISSUE? ARE THERE STRUCTURAL SOLUTIONS OR IS LEGISLATIVE
ACTION NEEDED?*

Dr. McClellan noted that this situation may affect as many as
70,000-80,000 individuals and that CMS is sending a letter out to remind
people that a risk of benefit loss is possible and to suggest they get
counseling regarding how best to proceed. At the same time, CMS is
working with employers to help resolve this problem for retiree health
benefit plans; many have been exceptionally responsive. Generally
speaking, it would not be appropriate to eliminate people from this
private coverage because they have been automatically enrolled in the
Medicare Drug Benefit program.

***Questions and Answers on Durable Medical Equipment (DME) Issues***

*MEDICAID EILGIBILITY FOR COVERAGE OF DURABLE MEDICAL EQUIPMENT, SUCH AS
WHEELCHAIRS, CONTINUES TO FOCUS ON THE NEED FOR SUCH DEVICES IN THE
HOME-BASED ENVIRONMENT. TODAY, MANY PERSONS WITH A DISABILITY DON'T
REMAIN IN THEIR HOME; THEY WORK AND ENGAGE IN THEIR COMMUNITIES. ARE
THERE ANY NEW OPTIONS AVAILABLE FOR COVERAGE OF DME?*

Dr. McClellan pointed out that CMS wants to get people out into the
community. Today's reality has outstripped the current long-standing
part of the Medicaid statute that restricts DME to home-based need. He
pointed out that while CMS has a demonstration now ongoing to examine
the effect of altering this aspect of the law and promote greater
community-based living opportunities for persons with DME needs. It will
take legislative change to remedy this situation.

*WHAT CAN BE DONE TO IMPROVE THE QUALITY OF THE DME FROM EQUIPMENT
SUPPLIERS AND TO PROMOTE THEIR RESPONSIVENESS TO REPORTED PROBLEMS WITH
THE EQUIPMENT?*

The fastest and easiest thing to do would be to call the 1-800-Medicare
toll-free number to connect with the complaint tracking system. Local
advocacy groups, also, can provide assistance at the community level.
Dr. Giannini indicated that she would engage Dr. McClellan further about
these DME issues.

***Questions and Answers: Other CMS Issues***

*AS A FOLLOW-ON FROM THE LAST CONSTITUENT INPUT MEETING, WHAT IS BEING
DONE REGARDING MEDICAID PORTABILITY FOR SURVIVORS OF THE RECENT
HURRICANES WHO HAVE BEEN RELOCATED TO OTHER STATES? ANECOTAL INFORMATION
SUGGESTS THAT SOME states are not providing services (such as
medications) available in the home state but optional in the states to
which individuals have been relocated. What can be done for persons with
disabilities who will be dislocated long-term?*

States are allowed to use the benefit structure that exists in their
State (or what was in the waiver package for their State). An
uncompensated care fund was put into the health care pool, but it has a
time limit of no longer than 3 months following evacuation. CMS is not
sure if that fund is renewable.

At the same time, CMS is working with the Office on Disability on
emergency preparedness issues to assess what has been successful and
less successful to help future response planning and oversight. This
includes issues such as that of portability. CMS and OD will continue to
keep disability constituent organizations informed.

**[Medicaid Disabled and Elderly Health Programs (DEHPG)]{.underline}**

***Strategic Plan***

Dr. Giannini introduced Gale Arden, Director of the DEHPG program who
reminded participants that the DEHPG handles a broad array of programs,
including both the home- and community-based Medicaid waiver program,
the Real Choice Program to promote the New Freedom Initiative, Medicaid
coverage issues for the disabled and elderly, and the Medicaid part of
the PACE program, among others.

She reminded everyone that when she took the helm at DEHPG about 2 years
ago, she began a strategic planning process, setting the first plan in
place in 2005. Ms. Arden also recalled that representatives from
disability constituencies commented on that first plan as the result of
a meeting similar to the one being convened today.

During the first year of strategic planning, DEHPG worked to identify
how ongoing work fit with the strategic planning process. Ms. Arden
directed meeting participants to the letter they received in their
mailing about the meeting that delineates the three guiding principles
and the goals of the Strategic Plan as well as the accomplishments
related to achieving the mission, vision and principles of the DEHPG
(See Appendix B).

Among the accomplishments has been the awarding of **approximately \$35
million in Real Choice Systems Change Grants**. However, perhaps most
important, the office redesigned the applications for home and
community-based waivers, simplifying the application, building in
quality control and emphasizing State self-direction and budgeting.
Critically, the new application allows states to approach milestones and
outcomes in an incremental manner.

Turning to the Strategic Plan for 2006, Ms. Arden noted that, from the
experience of 2005, the DEHPG is taking a more proactive strategic
approach by identifying the desired results and goals and setting in
place the strategies needed to achieve them them. She cautioned those at
the meeting that CMS actually has less direct leverage over the Medicaid
program than is commonly recognized. The DEHPG must work in partnership
with the States to achieve its goals and objectives, since States have a
pivotal role -- in implementation, structure and financing of the
Medicaid program. States operate the Medicaid program with broad
direction from CMS; CMS must help States build their capacity to move in
the direction CMS has specified for the people being served. (For
example, the use of Real Choice Grants can help States move toward
individual control and accountability for beneficiaries, as presented on
Goal 3 of the strategic plan.)

Working from the handout found at Attachment 2, Ms. Arden described the
2006 progress in strategic planning, suggesting areas in which further
work needs to be done -- whether with the States or with organizations
such as those at the current meeting, and with other Federal programs
and partners. She recognized that the structure of the Medicaid program
requires CMS to honor the knowledge States have on what works best for
their particular circumstances, but observed that CMS must challenge
itself to articulate desired outcomes and help the States achieve them.
For example, with respect to DEHPG's Goal 4 (see Appendix B), CMS is
working to find ways to help States build quality and quality
measurement into their programs, including the identification of
indicators and measures that States should set in place, without regard
to their unique circumstances or needs.

Provisions of the Budget Reconciliation Bill, if enacted into law, will
make some significant changes that will affect DEHPG and State
workloads. For example, the Home and Community-Based Service Program
will become part of State plans and no longer necessarily require a
waiver.

***Questions and Answers***

Dr Giannini opened the question/answer period by asking Ms. Arden to
articulate the major changes between 2005 and 2006 DEHPG programs. Ms.
Arden explained that the most salient changes include:

-   Expansion **of self direction in** the Home and Community-based
    Waiver Program as the result of the new waiver application.

-   Transformation of current State long-term care systems, given the
    increased State understanding that an integrated system needs to be
    built and that stove pipe approaches to programming and funding
    should be reduced.

-   Making larger amounts of system transformation funding available to
    enable States to approach system change from a more comprehensive
    perspective, with an evaluation of the success of such an approach
    later in 2006.

To what extent can CMS encourage States to look to constituent
organizations as partners in the development of home and community-based
service waivers or other programs?

While statute precludes the establishment of advisory committees to CMS
per se, it may be possible to create working groups that include
constituent organizations to provide feedback to CMS. The idea of having
States establish similar working groups of constituent organizations is
a good one. It's been suggested that requiring that kind of
collaboration in, for example, RFPs for Systems Change grants would
encourage States to engage in greater collaboration with constituency
groups.

Are there any ways in which CMS can address the "disconnect" between
Medicaid and private insurance or that can promote greater
accountability by private insurance company decisions?

Ms. Arden noted that the issue is a difficult one. Private insurance is
regulated by State Insurance Commissioners with a jurisdiction entirely
separate from the Medicaid programs in the States. Please consider
dropping a note to DEHPG regarding your concerns in this regard,
addressed to the attention of Susan Hill of our staff.

If home and community-based services programs become part of state
plans, will that mark the end of waivers?

Waivers will still be needed if states want to provide services to a
specific subset of the Medicaid population. The current legislation does
not now include the waiver of comparability, which effectively means you
can't target a particular population. However, it does say that you can
limit the number of people to be served. Thus, states must provide
services to all who meet ADL requirements on a first-come, first-served
basis, making it impossible to serve special populations with a waiver.
If a particular State wants to target the home and community- based
services to a particular population, they would have to use the waiver
program to do so.

Can states impose cost-sharing on mandatory populations?

Under section 1916 of the Social Security Act (the Act), States may
impose nominal cost sharing upon individuals described in section
1902(a)(10)(A)(i) of the Act, except that no deduction, cost sharing, or
similar charge will be imposed under the State Medicaid plan with
respect to:

\- Services furnished to individuals under 18 years of age (and, at the
option of the State, individuals under 21, 20, or 19 years of age, or
any reasonable category of individuals 18

years of age or over);

\- Services furnished to pregnant women, if such services relate to the
pregnancy or to any other medical condition which may complicate the
pregnancy (or, at the option of the State, any services furnished to
pregnant women;

\- Services furnished to any individual who is an inpatient in a
hospital, nursing facility, intermediate care facility, or other medical
institution, if such individual is required, as a condition of receiving
services in such institution under the State plan, to spend for costs of
medical care all but a minimal amount of the individual\'s income
required for personal needs;

\- Emergency services, as defined by the Secretary, family planning
services and supplies as described in section 1905(a)(4)(C), or (at the
option of the State) services furnished to such an individual by a
health maintenance organization, as defined in section 1903(m), in which
he is enrolled; and

\- Services furnished to an individual who is receiving hospice care as
defined in section 1905(o). Under the new section 1916A of the Act,
effective March 31, 2006, States have flexibility to implement
alternative cost sharing (which may exceed the nominal amounts imposed
under section 1916) for items and services, except for the following:

\* Services to certain individuals under age 18 and certain children in
foster care. These are individuals that the State is required to provide
Medicaid to under one of the mandatory eligibility groups in the law
(section 1902 (a)(10)(A)(i) of the Act) and children in foster care who
receive Medicaid on the basis of the receipt of benefits under title
IV-E of the Act and who receive services under title IV-B of the Act;

\* Preventive services (such as well baby and well child care and
immunizations) provided to children under 18 years of age regardless of
family income, as defined in Federal SCHIP regulations at 42 CFR
457.520;

\* Services to pregnant women, if such services relate to the pregnancy
or to any other medical condition which may complicate the pregnancy;

\* Services furnished to a terminally ill individual who is receiving
hospice care, as defined in section 1905(o) of the Act;

\* Services furnished to any individual who is an inpatient in a
hospital, nursing facility, intermediate care facility for the mentally
retarded, or other medical institution, if such individual is required,
as a condition of receiving services in such institution under the State
plan, to spend for costs of medical care all but a minimal amount of the
individual\'s income required for personal needs;

\* Emergency services as defined by the Secretary for the purposes of
section 1916(a)(2)(D) of the Act;

\* Family planning services as defined in section 1905(a)(4)(C) of the
Act; and

\* Services furnished to women eligible under the breast and cervical
cancer eligibility group (see sections 1902(a)(10)(A)(ii)(XVIII) and
1902(aa) of the Act).

**Closing Remarks**

Before closing the meeting, Dr. Giannini asked for any final comments
from participants.

-   A representative from National Brain Injury Research informed
    meeting participants that WETA, Washington's public television
    station, will be including a health segment within the News House
    show. Anyone wanting to include information could contact Susan
    Dentzer at the News Hour at WETA at 703.998.2600.

-   A participant from AAPD suggested that OD and CMS should work to
    promote inclusion of language in the State of the Union that
    supports the elimination of the institutional bias in Medicare and
    Medicaid.

Dr. Giannini thanked the participants and urged them to continue to
funnel issues regarding the Medicare Prescription Drug Benefit program
to OD for discussion with CMS and encouraged the continuing dialogue
about that program, the work of the DEHPG, and the issue of durable
medical equipment with both OD and CMS.

**Appendix A**

**Constituency Expert Input Meeting**

**Participating Constituent Organizations and Federal Agencies**

January 12, 2006

**[Constituency Organizations]{.underline}**

American Association on Mental Retardation

American Association of People with Disabilities

American Health Care Association

Association of University Centers on Disabilities

American Public Human Services Association/ Center for Workers with
Disabilities

American Network of Community Options and Resources (ANCOR)

California Independent Living Council

Epilepsy Foundation

Easter Seals of Massachusetts

Independent Living Centers

Living Independent Network Corporation

Lutheran Services in America

Medicare Rights Center

National Alliance for Caregiving

National Alliance on Mental Illness

National Association of Councils on Developmental Disabilities

National Association of State Directors of Developmental Disabilities
Services

National Brain Injury Research

National Congress of American Indians

National Council of the Blind

National Downs Syndrome Congress

National Organization on Disability

National Research Center for Women and Families

National Spinal Cord Injury Association

Not Dead Yet/ADAPT

SHIP Resource Center

The ARC

United Cerebral Palsy

Volunteers of America

VOR

**[Federal Participants]{.underline}**

Centers for Medicare and Medicaid Services

Social Security Administration

**APPENDIX B**

TO: All Interested Parties

FROM: Gale P. Arden, Director

Disabled and Elderly Health Programs Group (DEHPG)

SUBJ: Draft DEHPG Strategic Action Plan for Fiscal Year 2006

DATE: December 19, 2005

> Last year in 2005, the Disabled and Elderly Health Programs Group
> (DEHPG) of the Centers for Medicare & Medicaid Services (CMS) embarked
> upon a strategic planning process, specifically for our group. Our
> constituents provided vital input to this Plan and we are seeking your
> views and recommendations once again as we draft the 2006 Strategic
> Action Plan. I look forward to entering a dialogue with you at the
> January 12th meeting convened by the Office on Disability.
>
> DEHPG's strategic plan is a public declaration of the principles and
> vision that guide our day-to-day work. It is also a statement of
> accountability. The strategic plan outlines our goals and objectives
> for each year, and we anticipate that others will review our plan and
> observe our progress at meeting those goals.
>
> In addition to the draft 2006 Strategic Action Plan, you will find the
> DEHPG Accomplishments for 2005 attached to this letter. Several
> accomplishments have had a direct impact on our constituents and
> States. For instance, we continued our efforts to identify areas where
> technical assistance is needed and developed promising practices,
> building on the technical assistance documents previously released. In
> addition, the new draft of the 1915(c) HCBS waiver application was
> issued in June 2005, for voluntary use by States while CMS proceeds
> with formal clearance and publication. We also distributed refined
> guidance about the oversight of 1915(c) HCBS waivers and provided
> training to all CMS Regional Offices.
>
> In the midst of such exciting times in the Medicaid program, your
> involvement in the development of our 2006 Strategic Action Plan is
> critical. Thank you in advance for taking the time to offer your
> valuable input.

ATTACHMENT 1

**Disabled and Elderly Health Programs Group**

**Strategic Action Plan**

**2005 Accomplishments**

**Mission:** The Disabled and Elderly Health Programs Group provides
national leadership by assisting states and others in design of
financially sound Medicaid programs for eligible individuals with an
emphasis on long-term and pharmacy services and supports which foster
choice and opportunity for full participation in community life,
including independent living, economic self-sufficiency and recovery for
individuals of all ages.

**Vision:** To transform the ***provision of Medicaid services*** to
support individual choices and preferences.

**Guiding Principles:**

1.  State flexibility

2.  Accountability (program and personal)

3.  Individual choice

**Goal #1: Promote effective administration and oversight of Medicaid
programs for people who are elderly or disabled.**

**[Accomplishments]{.underline}**

-   Worked together with State Medicaid Agencies to facilitate
    beneficiaries' access to the new Prescription Drug Benefit (Part D)
    of the Medicare Modernization Act (MMA).

-   Provided extensive policy support within CMS on the Medicare Part D
    low-income subsidy and coordination of benefits.

-   Provided guidance to State Pharmacy Assistance Programs (SPAPs) to
    promote access to the Medicaid drug benefit and encourage
    cost-effective spending; initiated the SPAP Workgroup to exchange
    information and to identify solutions to policy issues that have an
    impact on States.

-   Supported States' initiatives to put into place cost avoidance
    claims payment practices through providing technical assistance.

**Goal #2: Support State innovation and State flexibility that is
responsive to the needs and desires of the beneficiaries of our
programs.**

**[Accomplishments]{.underline}**

-   Created opportunities, through awarding \$27 million in grants to
    ten States, to transform critical components of their health care
    systems.

-   Built State capacity to offer support services to individuals with
    disabilities to delay the need for cash assistance through providing
    technical assistance opportunities to Demonstration to Maintain
    Independence and Employment (DMIE) grantees.

-   Funded a National Technical Assistance Center to assist States in
    recruiting and retaining direct service workers.

-   Developed an inventory of Medicaid and non-Medicaid disease
    management programs in order to share program models with States and
    with other CMS components. Initiated an effort to facilitate States'
    interest in creating new programs to manage disease.

-   Developed policies and provided guidance to States on how to use
    section 1915(c) Home and Community Based Services waiver program
    authority to expand services for children with life-threatening
    illnesses through the Program of All Inclusive Care for Children.

-   Laid the groundwork for a new section 1115 research and
    demonstration template that would encourage States to undertake
    innovative approaches to providing long-term care services.

-   Continued to make progress on developing the final rule for the
    Program of All-Inclusive Care for the Elderly (PACE) to include
    flexibility waivers.

**Goal #3: Facilitate policies and programs that promote individual
control and accountability.**

**[Accomplishments]{.underline}**

-   Facilitated States' expansion of programs that incorporate
    opportunities for participants to direct and manage their waiver
    services through improving the 1915(c) Home and Community Based
    Services Waiver Application and integrating Independence Plus
    requirements.

-   Brought together 685 consumers, advocates, associations, technical
    assistance providers, States and CMS to identify and share best
    practices in community-based, consumer-directed care via the New
    Freedom Initiative Conference.

-   Supported States' efforts to develop consumer directed models of
    care through awarding \$6.5 million for 11, Medicaid Infrastructure
    grants that included a consumer directed component.

-   Provided \$1.7 million in funding to 10 States to develop
    Family-to-Family (FTF) Health Care Information and Education Center
    Grants.

-   Promoted the development of single point-of-entry systems to improve
    access to long-term care services through partnering with the
    Administration on Aging to award \$15 million to 19 States to create
    Aging and Disability Resource Centers.

-   Assessed the progress of States actively rebalancing their long-term
    supports systems to identify successful management and
    organizational approaches that can be used as examples for other
    States.

**Goal \# 4: Promote quality healthcare under the Medicaid program.**

**[Accomplishments]{.underline}**

-   Moved to outcomes-based reporting to demonstrate and document how
    grant programs are impacting the Medicaid program and the disability
    community.

-   Designed and implemented a Quality Management Strategy to ensure
    that the section 1915(c) Home and Community-Based Services Waiver
    programs continuously improve the effectiveness of the program in
    meeting participants' needs.

-   Provided technical assistance to States to build and enhance their
    quality management systems through the funding of a National
    Technical Assistance Contractor.

ATTACHMENT 2

**DRAFT Disabled and Elderly Health Programs Group**

**2006 Strategic Action Plan**

**Mission:** The Disabled and Elderly Health Programs Group provides
national leadership by assisting states and others in the design of
financially sound Medicaid programs for eligible individuals with an
emphasis on long-term and pharmacy services and supports which foster
choice and opportunity for full participation in community life,
including independent living, economic self-sufficiency and recovery for
individuals of all ages.

**Vision:** To transform the ***provision of Medicaid services*** to
support individual choices and preferences.

+-------------+--------------------------------------------------------+
| **GOAL 1.   |                                                        |
| ACCESS VIA  |                                                        |
| PAR         |                                                        |
| TNERSHIPS** |                                                        |
|             |                                                        |
| **Assure    |                                                        |
| elderly     |                                                        |
| individuals |                                                        |
| and         |                                                        |
| individuals |                                                        |
| with        |                                                        |
| d           |                                                        |
| isabilities |                                                        |
| benefit     |                                                        |
| from the    |                                                        |
| Medicaid    |                                                        |
| program by  |                                                        |
| expanding   |                                                        |
| and         |                                                        |
| st          |                                                        |
| rengthening |                                                        |
| p           |                                                        |
| artnerships |                                                        |
| with        |                                                        |
| States,     |                                                        |
| Federal     |                                                        |
| programs,   |                                                        |
| consumers,  |                                                        |
| advocates,  |                                                        |
| national    |                                                        |
| as          |                                                        |
| sociations, |                                                        |
| and other   |                                                        |
| CMS Centers |                                                        |
| and         |                                                        |
| groups.**   |                                                        |
+-------------+--------------------------------------------------------+
|             | Obj. A: Increase the support for and understanding of  |
|             | program changes through engaging stakeholders in       |
|             | developing policy.                                     |
+-------------+--------------------------------------------------------+
|             | Obj. B. Increase beneficiaries' access to the Part D   |
|             | Medicare Prescription Drug benefit through working     |
|             | with States to wrap-around and support efforts to      |
|             | implement the Medicare Modernization Act (MMA).        |
+-------------+--------------------------------------------------------+
| **GOAL 2:   |                                                        |
| INNOVATION  |                                                        |
| &           |                                                        |
| FL          |                                                        |
| EXIBILITY** |                                                        |
|             |                                                        |
| *           |                                                        |
| *Facilitate |                                                        |
| States'     |                                                        |
| efforts to  |                                                        |
| better      |                                                        |
| serve       |                                                        |
| be          |                                                        |
| neficiaries |                                                        |
| through     |                                                        |
| program     |                                                        |
| innovations |                                                        |
| and         |                                                        |
| fle         |                                                        |
| xibility.** |                                                        |
+-------------+--------------------------------------------------------+
|             | Obj. A: Increase beneficiaries' access to services and |
|             | service options through problem solving and solution   |
|             | finding with States which results in program           |
|             | innovations and flexibility.                           |
+-------------+--------------------------------------------------------+
|             | Obj. B: Increase support for State efforts to manage   |
|             | costs while ensuring programs operate in a manner      |
|             | consistent with law and regulations.                   |
+-------------+--------------------------------------------------------+
| **Goal #3:  |                                                        |
| CHOICE**    |                                                        |
|             |                                                        |
| **Help      |                                                        |
| be          |                                                        |
| neficiaries |                                                        |
| lead better |                                                        |
| lives by    |                                                        |
| advancing   |                                                        |
| policies    |                                                        |
| and         |                                                        |
| programs    |                                                        |
| that        |                                                        |
| facilitate  |                                                        |
| individual  |                                                        |
| choice and  |                                                        |
| control,    |                                                        |
| and promote |                                                        |
| community   |                                                        |
| living.**   |                                                        |
+-------------+--------------------------------------------------------+
|             | Obj. A: Build State capacity to develop health care    |
|             | delivery systems that provide individuals with choice  |
|             | and control over their lives.                          |
+-------------+--------------------------------------------------------+
| **Goal #4:  |                                                        |
| QUALITY**   |                                                        |
|             |                                                        |
| **Improve   |                                                        |
| the quality |                                                        |
| of services |                                                        |
| be          |                                                        |
| neficiaries |                                                        |
| receive by  |                                                        |
| better      |                                                        |
| defining    |                                                        |
| and         |                                                        |
| advancing   |                                                        |
| quality     |                                                        |
| principles  |                                                        |
| for our     |                                                        |
| programs.** |                                                        |
+-------------+--------------------------------------------------------+
|             | Obj. A: Build States' capacity for using quality       |
|             | elements and measures in order to continuously improve |
|             | each of our programs.                                  |
+-------------+--------------------------------------------------------+
|             | Obj. B: Improve responsiveness to States through       |
|             | increasing administrative efficiency and ensuring      |
|             | consistent program guidance and oversight.             |
+-------------+--------------------------------------------------------+

[^1]: The participant list is attached in Appendix A.