October 18, 2001

Centers For Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-2104-P
Room 443-G, Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201

To Whom It May Concern:

The undersigned national, state and local organizations submit the following comments regarding the Medicaid Managed Care Proposed Rule published in the Federal Register of August 20, 2001. These organizations represent a large and diverse group of Medicaid beneficiaries, including children, people with disabilities, seniors, and others. These comments were developed through the joint work of many of the organizations listed.

As you know, Congress enacted the Balanced Budget Act (BBA) in 1997 permitting states to require most Medicaid beneficiaries to be enrolled in managed care through a state plan amendment. In exchange, Congress included a number of important consumer protection and quality assurance requirements. We remain extremely concerned that over four years later, states can require enrollment in managed care, but beneficiaries are still waiting for their protections. In addition, we believe that, with few exceptions, the proposed rule is a significant step backward from the protections contained in the Final Rule issued by CMS in January. Many of our groups submitted comments and participated in the process that resulted in the January Final Rule. We are concerned that CMS has dismissed this public process, and many of the signatories to this letter have submitted separate comments questioning the legality of CMS' actions.

In addition to the specific comments that are attached, we would like to underscore a few general concerns. First, the proposed regulation fails to include many necessary provisions concerning notice to enrollees of their rights. These omissions could lead to violations of enrollee's due process rights. Without effective notice, enrollees will be unable to invoke their rights. The January regulations had a number of provisions which should be included to ensure that enrollees know their rights and are afforded a meaningful opportunity to exercise them. Second, the proposed regulations do not adequately protect Medicaid beneficiaries with special health care needs. In particular, the proposed regulations have removed numerous provisions from the January regulations that implemented key recommendations of the BBA-mandated Report to Congress entitled, Safeguards for Individuals with Special Health Care Needs Enrolled in Medicaid Managed Care. This report was required by Congress precisely because beneficiaries with special health care needs are especially vulnerable to being inadequately served in Medicaid managed care programs, and numerous studies had documented that state efforts had been insufficient at safeguarding special needs populations. Third, we are very concerned about the proposed exemption of prepaid ambulatory health plans from many of the requirements of the rule. By creating this new category, CMS is affording plans a way to organize their business in a way that avoids the few remaining protections that beneficiaries would still have under the proposed rule.

We believe strongly that four years of waiting for enforceable protections has been too long-and that the proposed regulations do not provide Medicaid beneficiaries with sufficient protections. While we are providing substantive comments on the NPRM, we urge you to implement the January final regulations immediately.

Thank you for your attention to our concerns. If you have any questions, please contact Joan Alker at Families USA 202/628 3030.

Sincerely

National Organizations:
AIDS Action
Alliance for Children and Families
American Association on Mental Retardation
American Federation of State, County, and Municipal Employees
American Network of Community Options and Resources
American Public Health Association
Bazelon Center for Mental Health Law
Center on Disability and Health
Child Welfare League of America
Children's Defense Fund
Council for Community Behavioral Healthcare
Epilepsy Foundation
Families USA
Family Voices
General Board of Church and Society of The United Methodist Church,
Ministry of Public Witness and Advocacy
National Association of Community Health Centers
National Association of People with AIDS
National Association of Social Workers
National Health Care for the Homeless Council
National Health Law Program
National Immigration Law Center
National Mental Health Association
National Minority AIDS Council
National Partnership for Women and Families
National Senior Citizens Law Center
Service Employees International Union
Title II Community AIDS National Network
United Cerebral Palsy Associations

State and Local Organizations:
California Pan-Ethic Health Network, Oakland, CA
Center for Public Policy Priorities, Austin, TX
Children's Hospital Oakland, Oakland, CA
Citizen Action of New York, Albany, NY
Citizens for Missouri's Children, St. Louis, MO
Delawareans with Special Needs, Wilmington, DE
Family & Children's Center Counseling & Developmental Services, Inc., South Bend, IN
Gay Men's Health Crisis, New York, NY
Greater Upstate Law Project, Inc., Rochester,NY
Health and Medicine Policy Research Group, Chicago, IL
Health Care Strategies, Inc., Carson City, NV
Long Island Health Access Monitoring Project, Huntington, NY
Michigan Association for Children with Emotional Disorders, Southfield, MI
Michigan Association for Infant Mental Health, East Lansing, MI
Michigan Legal Services, Detroit, MI
National Abortion Rights Action League, New York, NY
New Haven Federation of Teachers-Retiree Chapter, Local 933-R, New Haven, CT
New Jersey Protection & Advocacy, Inc., Trenton, NJ
New Mexico Council on Crime & Delinquency, Albuquerque, NM
New York Legal Assistance Group, New York, NY
Northwest Health Law Advocates, Seattle,WA
Office of Health Care Ombudsman, Burlington, VA
Oregon Advocacy Center, Portland, OR
Planned Parenthood of New York City, Inc., New York, NY
Public Justice Center, Baltimore, MD
San Francisco AIDS Foundation, San Francisco, CA
South Carolina Appleseed Legal Justice Center, Columbia, SC
UHCAN!, Cleveland, OH
Virginia Poverty Law Center, Richmond, VA
Women's Health & Family Planning Association of Texas, Austin, TX