CMS currently is working on controversial revisions to the Obama administration's network adequacy and access standards for Medicaid managed-care plans.

Matt Salo, executive director of the National Association of Medicaid Directors, praised the new CMS proposal on state reporting requirements as "a sensible step forward" because the 2015 regulation wasn't working. "We're all committed to meaningful access and to measuring that in ways that are outcomes-oriented," he said.

But other Medicaid experts warned that dropping the reporting requirements would make it more difficult to determine whether there are an adequate number of physicians and other providers available to serve patients in both the Medicaid fee-for-service and managed-care programs.

"They are eliminating the data that serves as an early warning system," said Sara Rosenbaum, a health law professor at George Washington University and former chair of the Medicaid and CHIP Payment and Access Commission. "Managed care is only feasible where there is an adequate supply of providers. If the network is illusory, you need to know that."

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“This is problematic, given that inclusion is the most cited strategy for instruction of children with exceptionalities, the majority of whom are served in general education settings,” CEC noted in a report about the survey.

More than half of students with disabilities spend at least 80 percent of their day in general education environments, according to federal data, so the ability of general education teachers and paraprofessionals to serve this population can have a significant impact.

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directing how states use funds, withdrawing funding, requiring a corrective action plan or involving the Education Department’s inspector general or the Department of Justice.

States that were found to meet requirements include Arizona, Connecticut, Florida, Indiana, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Montana, North Dakota, Nebraska, New Jersey, Ohio, Pennsylvania, South Dakota, Virginia, West Virginia, Wisconsin and Wyoming.

The remaining states and Washington, D.C. were given the “needs assistance” designation. No states were given the more dire labels of “needs intervention” or “needs substantial intervention.”

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Perhaps the biggest flaw is that the new reporting system only covers about a quarter of the people who have moved out of adult homes — those enrolled in what’s called Adult Home Plus, a special program where residents are assigned a “care coordinator” with a caseload of no more than 12 to meet with them four times a month and help them organize their services.

According to the latest figures in Sundram’s report, only 179 residents are enrolled in Adult Home Plus out of the 774 who have moved out.

Except for the neediest supported housing residents, that program is only supposed to last for the first six months after they move out. Sundram found that serious incidents often occur well after someone’s first six months in supported housing.

“We recommend strongly, as we have previously, that the requirements for Incident Reporting be extended to include all class members living in supported housing,” Sundram said in his report. “It seems incongruous that two class members could be sharing the same apartment and have different levels of protection based on factors that are not related to the potential risks they face.”

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She pushed Hyrum in his wheelchair while the mother and son attended the ceremonial signing on Thursday.

Now that the Katie Beckett waiver is in motion, likely meaning much-needed assistance for the family, Howes said the couple has stopped the process and will remain a family living under one roof.

"We're going to scrape by for another couple months until they get this set up for us," Howes said of the waiver.

TennCare and the Department of Developmental and Intellectual Disabilities is still in the process of crafting the plan for the program that it will submit to the federal government. The state has 120 days to do so from the time Lee officially signed the bill on May 24.

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Still, Hacienda isn’t perfect.

No one could have predicted sexual assault

The December story that first made headlines – the sexual assault and impregnation of a resident by her longtime nurse – was absolutely tragic. We don’t mean to diminish the pain experienced by the victim or her family.

Each of us would be destroyed should a family member be similarly victimized. At the same time, that single event, which could not have been predicted based on the nurse’s past, in no way reflects the care our loved ones have received at Hacienda.

In the aftermath of the sexual assault, Hacienda has responded with transparency, self-reporting this incident and cooperating with scores of inspections. Hundreds of thousands of dollars have been spent improving security and employing police officers to guard the residents – including from threats made by an angry public, which have deeply upset our families.

The reality? Hacienda’s interim CEO, Perry Petrilli, and its direct care teams have done excellent work responding to every request to improve the facility. They have spared no expense and it shows.

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If CMS approves the waiver, the change should be implemented in the first quarter of 2020, Marc Zimmet, the president and CEO of Zimmet Healthcare Services Group, told Skilled Nursing News.

“With Medicaid managed care in the nursing facility, this is what New York finally realized: It doesn’t make sense,” he said. “In the community, it makes all the sense in the world for a Medicaid patient to be in managed care. A managed care company can benefit; they can take risk, because the goal is to keep patients out of the hospital, keep them out of the nursing home.”

But once a patient is admitted to a SNF and becomes a long-stay resident, that logic no longer applies. When patients are in a nursing home, it’s much harder to reduce utilization, Zimmet argued, and cutting provider rates is unrealistic, given how low existing rates are.

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Medicaid Director Michael Randol said in a statement. “These new contracts demonstrate a commitment to those we serve including greater access to hepatitis C treatment and additional funding for the adult mental health and children’s mental health systems.”

Iowa Senate Democratic Leader Janet Petersen criticized the funding increase, calling the contracts “outrageous” and the privatized Medicaid program “unsustainable, unaffordable and unpredictable.”

“Gov. (Kim) Reynolds has once again agreed to give the (managed care organizations) the largest dollar increases for Medicaid in the last decade,” Petersen said in a statement, “ ... The big cheerleaders for privatized Medicaid — Gov. Reynolds and Republican legislators — cannot back up their claims that privatizing would save money and make people healthier. That’s because it hasn’t happened.”

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